Risk factors and antibiotic prophylaxis of cellulitis in cirrhosis

Sebahat Basyigit

Kecioren Research and Training Hospital, Ankara, Turkey
Department of Gastroenterology, Kecioren Research and Training Hospital, Ankara, Turkey

Correspondence to: Sebahat Basyigit, M.D., Kecioren Research and Training Hospital, Department of Gastroenterology, Pınarbasımh, Ardahan sk. Kecioren, Ankara, Turkey, Tel.: +90 3123 569000, Fax: +90 3123 569003, e-mail: sbuyuktemiz@yahoo.com
Received 6 December 2014; accepted 6 January 2015
© 2015 Hellenic Society of Gastroenterology

We read the article by Hamza et al with great interest [1]. The authors have investigated the risk factors and whether antibiotic prophylaxis helps prevent recurrence of cellulitis in cirrhosis. We agree with the authors that bacterial infections are frequent in cirrhotic patients because of their defective defense mechanisms and that these infections precipitate decompensation of cirrhosis. Of note, an association between high MELD for end-stage liver disease score and hepatic encephalopathy with cellulitis are expected as mentioned in phase 1 results of the study.

However, since the most common infection in advanced cirrhosis is spontaneous bacterial peritonitis (SBP), antibiotics for selective intestinal decontamination, such as quinolones, are often prescribed as prophylaxis against SBP recurrence [2]. The effect of widespread norfloxacin use on the epidemiology of severe infections in cirrhotic patients is poorly known. A 5-year retrospective study evaluated the effect of long-term administration of norfloxacin on the epidemiology of severe hospital-acquired infections and showed that long-term norfloxacin administration resulted in a sharp increase in staphylococcal SBP and bacteremia, while the prevalence of Enterobacteriaceae and streptococci fell and did not change, respectively [3].

Although gram-negative bacteria-induced cellulitis has been reported in cirrhotic patients [4], gram-positive bacteria are still the predominant organism isolated from cellulitis [5]. Recommended use of broad-spectrum antibiotics as prophylactic treatment of such patients may lead to the emergence of gram-positive pathogens rather than preventation of skin infections.

References

1. Hamza RE, Villyoth MP, Peter G, Risk factors of cellulitis in cirrhosis and antibiotic prophylaxis in preventing recurrenceAnn Gastroenterol 2014; 27: 374.

2. Tandon P, Garcia-Tsao G, Bacterial infections, sepsis and multiorgan failure in cirrhosisSemin Liver Dis 2008; 28: 26-42.

3. Campillo B, Dupeyron C, Richardet JP, Mangeney N, Leluan G, Epidemiology of severe hospital-acquired infections in patients with liver cirrhosis: effect of long-term administration of norfloxacinClin Infect Dis 1998; 26: 1066-1070.

4. Horowitz Y, Sperber AD, Almog Y, Gram-negative cellulitis complicating cirrhosisMayo Clin Proc 2004; 79: 247-250.

5. Joseph J, Abraham S, Soman A, Mathew LK, Ganga SV, Vijayan V, Cellulitis: a bacterial skin infection, their causes, diagnosis and treatmentWJPPS 2014; 3: 308-326.

Notes

Conflict of Interest: None