How do infections complicate acute liver failure (ALF)?

Updated: Jun 13, 2019
  • Author: Gagan K Sood, MD; Chief Editor: BS Anand, MD  more...
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Answer

Infection

Periodic surveillance cultures should be performed to detect bacterial and fungal infections. Empiric broad-spectrum antibiotics and antifungals should be given in the following circumstances:

  • Progressive encephalopathy (start antibiotics in all patients listed for transplantation)

  • Signs of systemic inflammatory response syndrome (SIRS) (temperature, >38°C or < 36°C; white blood cell [WBC] count, >12,000/μL or < 4,000/μL; pulse rate, >90 bpm)

  • Persistent hypotension

Piperacillin/tazobactam (Zosyn) and fluconazole should be the initial antimicrobial choice. In hospital-acquired intravenous (IV) catheter infections, consider vancomycin.


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