БАКТЕРИАЛЬНЫЕ ИНФЕКЦИИ У ПАЦИЕНТОВ С ЦИРРОЗОМ ПЕЧЕНИ
Аннотация
Бактериальные инфекции распространены у пациентов с циррозом печени, и наиболее частые – спонтанный бактериальный перитонит, пневмония, инфекция мочевыводящих путей. Пациенты с циррозом печени имеют ослабленный иммунитет и повышенную восприимчивость к спонтанным бактериальным инфекциям, – таким как спонтанный бактериальный перитонит (СБП). Не-СБП инфекции представляют собой разнородную по клиническим проявлениям и прогнозу группу. Грамотрицательные энтеробактерии, в первую очередь Escherichia coli, являются наиболее распространенными возбудителями внебольничных инфекций; грамположительные кокки наиболее часто определяются при нозокомиальных инфекциях. До 30% возбудителей нозокомиальных инфекций характеризуются как полирезистентные. После развития инфекции чрезмерная продукция провоспалительных цитокинов наслаивается на существующие при циррозе печени гемодинамические расстройства, что далее предопределяют развитие серьезных осложнений, таких как шок, «острая-на-хроническую» печеночная недостаточность, почечная недостаточность и смерть. Инфекции являются основной причиной смерти пациентов с прогрессирующим циррозом печени.
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