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Only for medical professionals to read for reference
, dry goods full ~ cirrhosis is usually the last stage of the development of a variety of liver diseases,
which can be divided into a compensatory phase (no obvious clinical symptoms) and a decompensation phase (combined with a variety of complications).
Decompensated cirrhosis can cause a variety of complications, such as ascites, upper gastrointestinal bleeding, hepatic encephalopathy, bacterial infections, etc.
, of which ascites and infection are the most common
.
The incidence of bacterial infection in hospitalized patients with acute decompensated cirrhosis was 25%~46%, and the risk of sepsis was 2.
6 times higher than that of patients without cirrhosis [1].
Abdominal infection is the most common type of
infection in patients with cirrhosis.
Relevant studies have found that patients with ascites with cirrhosis undergo abdominal puncture detection when hospitalized, and the incidence of spontaneous bacterial peritonitis (SBP) is about 27%, and the recurrence rate of SBP in patients with cirrhosis with a history of SBP within 12 months is as high as 40%~70%.
SBP can rapidly progress to liver and kidney failure, leading to further deterioration and is the leading cause of death in patients with end-stage liver disease [2].
In 2017, the Hepatology Branch of the Chinese Medical Association issued the "Guidelines for the Diagnosis and Treatment of Ascites and Related Complications in Cirrhosis" [3], recommending that patients with ascites polymorphonuclear cells < 0.
25×10<b25>9/L and symptoms or signs of infection should also receive anti-infective therapy while waiting for culture results
.
In the selection of antimicrobial drugs, treatment regimens must consider the location of infection, the severity of infection and local antibiotic resistance, personal drug history, and history of bacterial infection
.
1Empiric anti-infective therapy for SBP According to the Guidelines for the Diagnosis and Treatment of Ascites and Related Complications in Cirrhosis[3], empiric treatment of community-acquired SBP should cover gram-negative Enterobacter and gram-positive cocci, and select antibacterial drugs
that can cover anaerobic bacteria as much as possible 。 For hospital-acquired SBP, empiric antimicrobial therapy should be based on local microbiological findings, and multi-agent combination regimens involving broad-spectrum anti-gram-negative and anaerobic organisms are recommended for coverage of probable pathogens
.
Table 1 Empiric anti-infective therapy
for SBP In addition, empiric treatment requires bacterial culture of ascites, and more sensitive antibacterial drugs
are replaced in time according to the bacterial culture results.
2 Intestinal non-absorbable antibacterial drug rifaximin is a derivative of rifamycin, which can inhibit the growth of bacteria in the intestine on a broad spectrum and potently, and has bactericidal/bacteriostatic, immunomodulatory and anti-inflammatory effects
。 China's Expert Consensus on the Diagnosis and Treatment of End-Stage Liver Disease Complicated Infection (2021 Edition) recommends the use of short-term preventive intestinal selective purification therapy for high-risk patients, that is, the use of narrow-spectrum antibacterial drugs such as rifaximin to remove intestinal gram-negative bacilli, inhibit the overgrowth of intestinal bacteria, reduce the production of intestinal endotoxins, improve the colonization capacity of normal anaerobic bacteria in the intestine, and reduce the risk
of SBP.
The 2018 Guidelines for the Diagnosis and Treatment of Hepatic Encephalopathy with Cirrhosis also recommend rifaximin α crystal forms for reducing the symptoms of hepatic encephalopathy and preventing the occurrence of
hepatic encephalopathy.
Human blood albumin can increase colloidal osmotic pressure, is an important carrier in blood components, and has important functions
such as maintaining blood volume and promoting blood circulation, binding, transporting substances and anti-peroxidation.
In patients with cirrhosis, the amount of human albumin synthesis and the function of synthesized albumin decreased, resulting in a decrease in albumin concentration, which seriously affected physiological functions and even aggravated the progression of
liver disease.
The 2009 AASLD guidelines and the 2010 EASL guidelines recommend human albumin combined with diuretics for the treatment of ascites in cirrhosis, and transfusion of human albumin combined with antibacterial drugs can reduce the occurrence of hepatorenal syndrome and reduce the mortality rate
in patients with SBP.
Studies have found that the addition of human albumin 1.
5 g/kg within 6 hours after cefotaxime and 1.
0 g/kg on day 3 in patients with SBP significantly reduces the risk of hepatorenal syndrome and death [4].
Indications: Empiric basic treatment regimen
for SBP.
Ceftaxime is used to treat sepsis, purulent meningitis, respiratory, urinary tract, biliary tract, abdominal infection, genitourinary infection, etc
.
caused by sensitive bacteria.
Medication analysis: Suspected SBP can be selected with cefotaxime or similar three-generation cephalosporin antibacterial drugs, which can cover 95% of bacteria
.
For patients with mild to moderate SBP in communities without recent β-lactam antimicrobials, third-generation cephalosporin monooperative empiric therapy
is preferred.
Ceftaxime is a time-dependent drug with strong tissue penetrating power, widely distributed in the body, and can reach effective concentrations
in tissues, body cavities, and body fluids.
In intra-abdominal infection, cefotaxime can improve efficacy by increasing the frequency of administration and increasing the percentage of time between doses of MIC exceeds [5].
Note: Patients with severe renal function should reduce the dose appropriately, and when CrCl < 20ml/min, the maintenance dose should be halved
.
.
Medication analysis: cefepime is a fourth-generation cephalosporin antibiotic, with a wider antibacterial spectrum than the third-generation cephalosporin antibiotics, and is active against gram-negative bacteria (including Pseudomonas aeruginosa); More stable to β-lactamase; It is more active against gram-positive cocci than third-generation cephalosporin antibiotics
.
Cefepime has no antimicrobial activity against anaerobic bacteria, so it must be combined with nitroimidazole antianaerobic drugs
when used to treat aerobic and anaerobic mixed infections.
Note: Both cefepime and metronidazole have obvious gastrointestinal reactions and should be closely followed
.
Indications: Indicated for severe community-acquired and hospital-acquired SBP
.
It is used for the treatment of mixed infections of aerobic bacteria and anaerobic bacteria such as peritonitis and other abdominal infections, sepsis, endometritis and other female reproductive system infections
.
Drug analysis: β-lactamase inhibitors can bind to most of the β-lactamase produced by bacteria, inactivate them, protect the β-lactam ring in antibiotics from hydrolysis, and protect the antibacterial effect
of β-lactam antibiotics.
Most SBP infections are caused by gram-negative bacteria, particularly E.
coli and Klebsiella
pneumoniae.
Enterobacteriaceae have low resistance rate and good sensitivity to β-lactamase combination
preparations.
Extended-spectrum β-lactamases (ESBLs) are mostly derived from Enterobacteriaceae bacteria, and piperacillintam, azolbactam, can be used to treat mild to moderate infections
caused by ESBLs-producing strains.
Note: Common adverse reactions are candida infection, thrombocytopenia, anemia, etc.
, and rare adverse reactions include leukopenia or even agranulocytosis, hypokalemia, hypotension, phlebitis, joint and muscle pain, etc
.
Appropriate care should be taken
during clinical use.
Indications: Suitable for mild to moderate community-acquired SBP
.
Medication analysis: the antibacterial spectrum is similar to the third-generation cephalosporin and broader, the antibacterial activity against G-bacillus is stronger than that of G+ coccus, and fluoroquinolones plus metronidazole is a reasonable empirical treatment option
for patients with mild to moderate community-acquired infections who do not have risk factors for antibiotic-resistant microorganisms.
Note: Levofloxacin can cause angioedema (including pharyngeal, laryngeal or facial edema), urticaria, itching and other allergic reactions; It can also cause photosensitivity reactions, and should avoid sun exposure or exposure to artificial ultraviolet rays
.
Levofloxacin is mainly excreted by the kidneys, and patients with reduced renal function need to adjust the dose
.
Indications: for the treatment of intestinal infections caused by sensitive bacteria, for adjuvant therapy
of hyperammonemia (hepatic encephalopathy).
Medication analysis: The etiology of hepatic encephalopathy is complex, and bacterial translocation and enterotoxin metabolism abnormalities caused by excessive bacterial growth, intestinal mucosal barrier damage and gastrointestinal motility disorders may be the pathogenesis
of hepatic encephalopathy.
Rifaximin can play a role in the prevention and treatment of liver cirrhosis, SBP and refractory ascites by killing ammonia-producing bacteria, reducing the source of ammonia and improving endotoxemia [6].
Note: Dizziness, headache, constipation, abdominal pain, bloating, diarrhea, nausea, urgency to defecate, vomiting, fever and other side effects
may occur after medication.
Indications: For the treatment of mild to moderate community-acquired SBP
.
Drug analysis: Meropenem belongs to the ultra-broad-spectrum carbapenem class, which is effective against gram-negative bacilli, gram-positive cocci and anaerobic bacteria, and belongs to time-dependent antibacterial drugs
.
Meropenem has a good effect on multidrug-resistant gram-negative bacilli, such as β-lactamase-producing bacteria recommended for the treatment of clinical infections (Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Enterobacter cloacae, etc.
).
Note: Meropenem is mainly metabolized and excreted by the kidneys, and attention should be paid to adjusting the dose
of meropenem for patients with hepatorenal syndrome complicated by cirrhosis or patients with renal insufficiency.
Patients who are taking valproate are contraindicated
.
Indications: for the treatment of hospital-acquired SBP, suitable for complex intra-abdominal infection, complicated skin and skin soft tissue infection, and community-acquired pneumonia
caused by sensitive bacteria.
Medication analysis: Tigecycline can cover G+ bacteria, G- bacteria, anaerobic bacteria and atypical pathogens in a broad spectrum, and is not affected by common bacterial resistance mechanisms such as ESBls-producing bacteria, target modification, and efflux pumps, and is suitable for moderate to severe drug-resistant intra-celiac infections
.
Precautions: Patients with mild to moderate hepatic impairment (Child Pugh grades A and B) do not require dose
adjustment.
Tigecycline should be given to patients with severe hepatic impairment (Child Pugh class C) at a dose of 100 mg followed by 25 mg
every 12 hours.
The adverse reactions of tigecycline are mainly the effects on the coagulation system and gastrointestinal system, mainly manifested as: prothrombin time (PT) and partial thromboplastin time (APTT) significantly prolonged, fibrinogen (FIB) decreased, nausea, vomiting and other gastrointestinal reactions, increased amylase, acute pancreatitis, increased stool frequency, etc
.
In addition, tigecycline can also cause liver function damage (such as elevated transaminases, bilirubin and alkaline phosphatase), as well as cytopenias, rash, palpitations, etc.
, which should attract clinical attention
.
Indications: Indicated for hospital-acquired SBP
with severe drug resistance.
Medication analysis: Polymyxins are recommended for the treatment of severe infections caused by severely resistant gram-negative bacteria [carbapene-resistant Enterobacteriaceae (CRE), Acinetobacter baumannii (CRAB), and Pseudomonas aeruginosa (CRPA)], and should be given a loading dose [7].
The 2016 Expert Consensus on Antimicrobial Treatment for Extensively Drug-Resistant Gram-Negative Infections recommends polymyxin for the treatment of CRE intra-celiac infection
.
Note: The main adverse reactions of polymyxins are mainly nephrotoxicity and neurotoxicity, and the use of polymyxins should not exceed the dose recommended by consensus, avoid the simultaneous use of other nephrotoxic drugs, and it is recommended to carry out therapeutic drug monitoring (TDM).
Expert profiles
at the references:
, dry goods full ~ cirrhosis is usually the last stage of the development of a variety of liver diseases,
which can be divided into a compensatory phase (no obvious clinical symptoms) and a decompensation phase (combined with a variety of complications).
Decompensated cirrhosis can cause a variety of complications, such as ascites, upper gastrointestinal bleeding, hepatic encephalopathy, bacterial infections, etc.
, of which ascites and infection are the most common
.
The incidence of bacterial infection in hospitalized patients with acute decompensated cirrhosis was 25%~46%, and the risk of sepsis was 2.
6 times higher than that of patients without cirrhosis [1].
Abdominal infection is the most common type of
infection in patients with cirrhosis.
Relevant studies have found that patients with ascites with cirrhosis undergo abdominal puncture detection when hospitalized, and the incidence of spontaneous bacterial peritonitis (SBP) is about 27%, and the recurrence rate of SBP in patients with cirrhosis with a history of SBP within 12 months is as high as 40%~70%.
SBP can rapidly progress to liver and kidney failure, leading to further deterioration and is the leading cause of death in patients with end-stage liver disease [2].
In 2017, the Hepatology Branch of the Chinese Medical Association issued the "Guidelines for the Diagnosis and Treatment of Ascites and Related Complications in Cirrhosis" [3], recommending that patients with ascites polymorphonuclear cells < 0.
25×10<b25>9/L and symptoms or signs of infection should also receive anti-infective therapy while waiting for culture results
.
First, the choice of antibacterial drugs
In the selection of antimicrobial drugs, treatment regimens must consider the location of infection, the severity of infection and local antibiotic resistance, personal drug history, and history of bacterial infection
.
1Empiric anti-infective therapy for SBP According to the Guidelines for the Diagnosis and Treatment of Ascites and Related Complications in Cirrhosis[3], empiric treatment of community-acquired SBP should cover gram-negative Enterobacter and gram-positive cocci, and select antibacterial drugs
that can cover anaerobic bacteria as much as possible 。 For hospital-acquired SBP, empiric antimicrobial therapy should be based on local microbiological findings, and multi-agent combination regimens involving broad-spectrum anti-gram-negative and anaerobic organisms are recommended for coverage of probable pathogens
.
Table 1 Empiric anti-infective therapy
for SBP In addition, empiric treatment requires bacterial culture of ascites, and more sensitive antibacterial drugs
are replaced in time according to the bacterial culture results.
2 Intestinal non-absorbable antibacterial drug rifaximin is a derivative of rifamycin, which can inhibit the growth of bacteria in the intestine on a broad spectrum and potently, and has bactericidal/bacteriostatic, immunomodulatory and anti-inflammatory effects
。 China's Expert Consensus on the Diagnosis and Treatment of End-Stage Liver Disease Complicated Infection (2021 Edition) recommends the use of short-term preventive intestinal selective purification therapy for high-risk patients, that is, the use of narrow-spectrum antibacterial drugs such as rifaximin to remove intestinal gram-negative bacilli, inhibit the overgrowth of intestinal bacteria, reduce the production of intestinal endotoxins, improve the colonization capacity of normal anaerobic bacteria in the intestine, and reduce the risk
of SBP.
The 2018 Guidelines for the Diagnosis and Treatment of Hepatic Encephalopathy with Cirrhosis also recommend rifaximin α crystal forms for reducing the symptoms of hepatic encephalopathy and preventing the occurrence of
hepatic encephalopathy.
Second, intravenous transfusion of human albumin
Human blood albumin can increase colloidal osmotic pressure, is an important carrier in blood components, and has important functions
such as maintaining blood volume and promoting blood circulation, binding, transporting substances and anti-peroxidation.
In patients with cirrhosis, the amount of human albumin synthesis and the function of synthesized albumin decreased, resulting in a decrease in albumin concentration, which seriously affected physiological functions and even aggravated the progression of
liver disease.
The 2009 AASLD guidelines and the 2010 EASL guidelines recommend human albumin combined with diuretics for the treatment of ascites in cirrhosis, and transfusion of human albumin combined with antibacterial drugs can reduce the occurrence of hepatorenal syndrome and reduce the mortality rate
in patients with SBP.
Studies have found that the addition of human albumin 1.
5 g/kg within 6 hours after cefotaxime and 1.
0 g/kg on day 3 in patients with SBP significantly reduces the risk of hepatorenal syndrome and death [4].
3.
Analysis of common prescriptions for SBP
■ Prescription 1
Ceftaxime 2 g, Q6-8h
.
Indications: Empiric basic treatment regimen
for SBP.
Ceftaxime is used to treat sepsis, purulent meningitis, respiratory, urinary tract, biliary tract, abdominal infection, genitourinary infection, etc
.
caused by sensitive bacteria.
Medication analysis: Suspected SBP can be selected with cefotaxime or similar three-generation cephalosporin antibacterial drugs, which can cover 95% of bacteria
.
For patients with mild to moderate SBP in communities without recent β-lactam antimicrobials, third-generation cephalosporin monooperative empiric therapy
is preferred.
Ceftaxime is a time-dependent drug with strong tissue penetrating power, widely distributed in the body, and can reach effective concentrations
in tissues, body cavities, and body fluids.
In intra-abdominal infection, cefotaxime can improve efficacy by increasing the frequency of administration and increasing the percentage of time between doses of MIC exceeds [5].
Note: Patients with severe renal function should reduce the dose appropriately, and when CrCl < 20ml/min, the maintenance dose should be halved
.
■ Prescription 2
Cefepime 2g, Q8H + metronidazole 0.
5g, Q12-8H
.
.
Medication analysis: cefepime is a fourth-generation cephalosporin antibiotic, with a wider antibacterial spectrum than the third-generation cephalosporin antibiotics, and is active against gram-negative bacteria (including Pseudomonas aeruginosa); More stable to β-lactamase; It is more active against gram-positive cocci than third-generation cephalosporin antibiotics
.
Cefepime has no antimicrobial activity against anaerobic bacteria, so it must be combined with nitroimidazole antianaerobic drugs
when used to treat aerobic and anaerobic mixed infections.
Note: Both cefepime and metronidazole have obvious gastrointestinal reactions and should be closely followed
.
■ Prescription 3
Piracillin/tazobactam 4.
5 g, Q8-6H
.
Indications: Indicated for severe community-acquired and hospital-acquired SBP
.
It is used for the treatment of mixed infections of aerobic bacteria and anaerobic bacteria such as peritonitis and other abdominal infections, sepsis, endometritis and other female reproductive system infections
.
Drug analysis: β-lactamase inhibitors can bind to most of the β-lactamase produced by bacteria, inactivate them, protect the β-lactam ring in antibiotics from hydrolysis, and protect the antibacterial effect
of β-lactam antibiotics.
Most SBP infections are caused by gram-negative bacteria, particularly E.
coli and Klebsiella
pneumoniae.
Enterobacteriaceae have low resistance rate and good sensitivity to β-lactamase combination
preparations.
Extended-spectrum β-lactamases (ESBLs) are mostly derived from Enterobacteriaceae bacteria, and piperacillintam, azolbactam, can be used to treat mild to moderate infections
caused by ESBLs-producing strains.
Note: Common adverse reactions are candida infection, thrombocytopenia, anemia, etc.
, and rare adverse reactions include leukopenia or even agranulocytosis, hypokalemia, hypotension, phlebitis, joint and muscle pain, etc
.
Appropriate care should be taken
during clinical use.
■ Prescription 4
Levofloxacin 0.
5 g, QD + metronidazole 0.
5 g, Q12-8H
.
Indications: Suitable for mild to moderate community-acquired SBP
.
Medication analysis: the antibacterial spectrum is similar to the third-generation cephalosporin and broader, the antibacterial activity against G-bacillus is stronger than that of G+ coccus, and fluoroquinolones plus metronidazole is a reasonable empirical treatment option
for patients with mild to moderate community-acquired infections who do not have risk factors for antibiotic-resistant microorganisms.
Note: Levofloxacin can cause angioedema (including pharyngeal, laryngeal or facial edema), urticaria, itching and other allergic reactions; It can also cause photosensitivity reactions, and should avoid sun exposure or exposure to artificial ultraviolet rays
.
Levofloxacin is mainly excreted by the kidneys, and patients with reduced renal function need to adjust the dose
.
■ Prescription 5
Rifaximin 400mg, TID
.
Indications: for the treatment of intestinal infections caused by sensitive bacteria, for adjuvant therapy
of hyperammonemia (hepatic encephalopathy).
Medication analysis: The etiology of hepatic encephalopathy is complex, and bacterial translocation and enterotoxin metabolism abnormalities caused by excessive bacterial growth, intestinal mucosal barrier damage and gastrointestinal motility disorders may be the pathogenesis
of hepatic encephalopathy.
Rifaximin can play a role in the prevention and treatment of liver cirrhosis, SBP and refractory ascites by killing ammonia-producing bacteria, reducing the source of ammonia and improving endotoxemia [6].
Note: Dizziness, headache, constipation, abdominal pain, bloating, diarrhea, nausea, urgency to defecate, vomiting, fever and other side effects
may occur after medication.
■ Prescription 6
Meropenem 1g, Q8H
.
Indications: For the treatment of mild to moderate community-acquired SBP
.
Drug analysis: Meropenem belongs to the ultra-broad-spectrum carbapenem class, which is effective against gram-negative bacilli, gram-positive cocci and anaerobic bacteria, and belongs to time-dependent antibacterial drugs
.
Meropenem has a good effect on multidrug-resistant gram-negative bacilli, such as β-lactamase-producing bacteria recommended for the treatment of clinical infections (Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Enterobacter cloacae, etc.
).
Note: Meropenem is mainly metabolized and excreted by the kidneys, and attention should be paid to adjusting the dose
of meropenem for patients with hepatorenal syndrome complicated by cirrhosis or patients with renal insufficiency.
Patients who are taking valproate are contraindicated
.
■ Prescription 7
tigecycline loading dose 100 mg, maintenance dose 50 mg, q12 hours
.
Indications: for the treatment of hospital-acquired SBP, suitable for complex intra-abdominal infection, complicated skin and skin soft tissue infection, and community-acquired pneumonia
caused by sensitive bacteria.
Medication analysis: Tigecycline can cover G+ bacteria, G- bacteria, anaerobic bacteria and atypical pathogens in a broad spectrum, and is not affected by common bacterial resistance mechanisms such as ESBls-producing bacteria, target modification, and efflux pumps, and is suitable for moderate to severe drug-resistant intra-celiac infections
.
Precautions: Patients with mild to moderate hepatic impairment (Child Pugh grades A and B) do not require dose
adjustment.
Tigecycline should be given to patients with severe hepatic impairment (Child Pugh class C) at a dose of 100 mg followed by 25 mg
every 12 hours.
The adverse reactions of tigecycline are mainly the effects on the coagulation system and gastrointestinal system, mainly manifested as: prothrombin time (PT) and partial thromboplastin time (APTT) significantly prolonged, fibrinogen (FIB) decreased, nausea, vomiting and other gastrointestinal reactions, increased amylase, acute pancreatitis, increased stool frequency, etc
.
In addition, tigecycline can also cause liver function damage (such as elevated transaminases, bilirubin and alkaline phosphatase), as well as cytopenias, rash, palpitations, etc.
, which should attract clinical attention
.
■ Prescription 8
Polymyxin
.
Indications: Indicated for hospital-acquired SBP
with severe drug resistance.
Medication analysis: Polymyxins are recommended for the treatment of severe infections caused by severely resistant gram-negative bacteria [carbapene-resistant Enterobacteriaceae (CRE), Acinetobacter baumannii (CRAB), and Pseudomonas aeruginosa (CRPA)], and should be given a loading dose [7].
The 2016 Expert Consensus on Antimicrobial Treatment for Extensively Drug-Resistant Gram-Negative Infections recommends polymyxin for the treatment of CRE intra-celiac infection
.
Note: The main adverse reactions of polymyxins are mainly nephrotoxicity and neurotoxicity, and the use of polymyxins should not exceed the dose recommended by consensus, avoid the simultaneous use of other nephrotoxic drugs, and it is recommended to carry out therapeutic drug monitoring (TDM).
Expert profiles
Professor Cao Xiaocang
- Chief physician and professor of the Department of Gastroenterology of Tianjin Medical University General Hospital, master tutor of Tianjin Medical University, Ph.
D.
of Peking Union Medical College∙Tsinghua University Health Science Center, postdoctoral fellow of Texas State University School of Medicine, and postdoctoral visiting scholar
of University of Lille School of Medicine, France.
- Member of the Digestive Endoscopy Committee of the Inflammatory Bowel Disease Group of the Gastroenterology Branch of the Chinese Medical Association, Vice Chairman of the Youth Committee of the Behavioral Medicine Branch of the Chinese Medical Association, Member of the Clinical Epidemiology Collaborative Group of the Gastroenterology Branch of the Chinese Medical Association, Member of the Inflammatory Bowel Disease Group of the Gastroenterology Branch of the Chinese Medical Equipment Association, Member of the Intractable Diseases Professional Committee of the Inflammatory Enterology Professional Committee of the Proctology Branch of the Chinese Medical Doctor Association, Member of the Inflammatory Bowel Disease Expert Committee of the Digestive Endoscopy Professional Committee of the Chinese Society of Integrative Medicine, Member of the Inflammatory Bowel Disease Expert Committee of Beijing Medical Award Foundation, Member of the Standing Committee of the Inflammatory Bowel Disease Alliance of Wu Jieping Medical Foundation, Member of the Standing Committee of the Intestinal Microecology Professional Committee, Member of the Standing Committee of the Stem Cell Engineering Technology Branch of the Chinese Society of Biomedical Engineering, and Vice Chairman of the Inflammatory Bowel Group of the Gastroenterology Branch of Tianjin Medical Association
- Research interests: biological therapy and cell therapy for autoimmune diseases of inflammatory bowel disease and digestive tract immune diseases, especially clinical application research of mesenchymal stem cell transplantation
.
His research achievements have been awarded by international conferences such as the American Annual Conference of Gastroenterology and the Annual Conference of Gastroenterology of the European Union, and dozens of papers
have been published in SCI journals and Chinese journals.
Xie Dong
Clinical pharmacist of General Hospital of Tianjin Medical University, clinical pharmacist of gastroenterology specialty teaching of National Clinical Pharmacist Training Base, and MTM pharmacist certified by the American Pharmacists
Association (APhA).
Li Yuanyuan
Clinical pharmacist, Tianjin Fourth Central Hospital
at the references:
[1] LI Beiling, CHEN Jinjun.
Progress and challenges in the diagnosis and treatment of abdominal infection in cirrhosis.
Journal of Clinical Hepatobiliary Diseases,2021,37(4):757-760.
[2] Simonetto DA, Piccolo Serafim L, Gallo de Moraes A, et al.
Management of Sepsis in Patients With Cirrhosis: Current Evidence and Practical Approach.
Hepatology, 2019, 70(1): 418-428.
[3] Hepatology Branch of Chinese Medical Association.
Guidelines for the diagnosis and treatment of ascites and related complications in cirrhosis.
Journal of Practical Hepatology,2018,21(1):21-31.
[4] Thévenot T, Bureau C, Oberti F，et al． Effect of albumin in cirrhotic patients with infection other than spontaneous bacterial peritonitis.
A randomized trial． J Hepatol，2015, 62(4): 822-830．
[5] Solomkin JS, Mazuski JE, Bradley JS, et al.
Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America.
Clin Infect Dis.
2010,50(2):133-64.
[6] Hepatology Branch of Chinese Medical Association.
Guidelines for the diagnosis and treatment of hepatic encephalopathy with cirrhosis.
Chinese Journal of Hepatology,2018,26(10):721-736.
[7] Critical Care Medicine Professional Committee of China Research Hospital Association, Evidence Based and Translational Professional Committee of Infectious Diseases of China Research Hospital Association.
Chinese expert consensus on clinical application of polymyxin[J].
Chinese Critical Care Emergency Medicine,2019,31(10):1194-1198.
)
[8] Wang Xiang.
Value of intravenous albumin infusion in the treatment of spontaneous peritonitis[J].
Frontiers in Medicine,2016,6(19):138-139.
)
