Infectious endocarditis in the case of cirrhosis: where do we stand?

Eur J Gastroenterol Hepatol. 2018 Dec;30(12):1406-1410. doi: 10.1097/MEG.0000000000001211.

Abstract

Bacterial infections are common in the case of cirrhosis and represent a major cause of morbidity and mortality. The most frequent infections are spontaneous bacterial peritonitis, urinary tract infection, and pneumonia, but few data on infectious endocarditis are available. Infectious endocarditis is a rare event, and diagnosis can be made at all stages of Child-Pugh classification. In the case of cirrhosis, the clinical features and bacterial ecology are similar to that of the general population (two males/one female, preferential location on the aortic and mitral valves, history of heart disease, majority of Gram-positive bacteria), but in-hospital mortality is higher. The Child-Pugh score and a history of decompensation have been identified as independent predictive factors for in-hospital mortality and a Child-Pugh score more than C10 was associated with a higher risk of death. Less frequent use of aminoglycosides, rifampin, and cardiac surgery has been described in cirrhotic patients, probably because of potential toxicity. Nevertheless, as they are a cornerstone of therapy, prospective studies on the impact of these therapeutics are warranted to improve outcome in this population of patients.

Publication types

  • Review

MeSH terms

  • Endocarditis, Bacterial / complications*
  • Endocarditis, Bacterial / diagnosis
  • Endocarditis, Bacterial / microbiology
  • Endocarditis, Bacterial / therapy
  • Humans
  • Liver Cirrhosis / complications*
  • Opportunistic Infections / complications*
  • Opportunistic Infections / diagnosis
  • Opportunistic Infections / microbiology
  • Opportunistic Infections / therapy
  • Prognosis