Early Diagnosis and Prevention of Infection in Cirrhosis

Infections in cirrhosis can be caused due to immune dysfunctions, altered microbiota and external factors including medications and exposures. In most cases, it has been seen that usual signs of infection may be absent in patients due to impaired immune response leading to delay and diagnosis.

Hence, it can be said that early diagnosis is a major problem among cirrhotic patients. Additionally, several other challenges add to the existing diagnostic burden, such as: Logistic barrier; challenges with culture-positivity; delay in turnaround time; prevalence of multidrug-resistant (MDR) organisms; prevalence of viral and fungal infections.

Therefore, there is an urgent need for non-culture-based strategies. Although cultureindependent techniques are being developed to tackle several problems associated with culture-dependent techniques such as contamination with host DNA and the inability to distinguish between dead and live bacteria, they are not ready for prime time yet.

Currently, several factors that can be used to improve diagnosis and prevent infection are: High index of suspicion and adequate coverage of MDR and fungal infections; up-todate vaccinations; nonantibiotic medications, such as statins and beta-blockers; removal of unnecessary PPI and antibiotic; consideration for continued masking.