Chronic Liver Disease Impairs Bacterial Clearance in a Human Model of Induced Bacteremia

Alix Ashare; Clark Stanford; Patricia Hancock; Donna Stark; Kathleen Lilli; Emily Birrer; Amanda Nymon; Kevin C Doerschug; Gary W Hunninghake

doi:10.1111/j.1752-8062.2009.00122.x

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Chronic Liver Disease Impairs Bacterial Clearance in a Human Model of Induced Bacteremia

Journal article

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Chronic Liver Disease Impairs Bacterial Clearance in a Human Model of Induced Bacteremia

Alix Ashare, Clark Stanford, Patricia Hancock, Donna Stark, Kathleen Lilli, Emily Birrer, Amanda Nymon, Kevin C Doerschug and Gary W Hunninghake

Clinical and translational science, Vol.2(3), pp.199-205

06/2009

DOI: 10.1111/j.1752-8062.2009.00122.x

PMCID: PMC3415466

PMID: 20443893

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Abstract

Sepsis often causes impaired hepatic function. Patients with liver disease have an increased risk of bacteremia. This is thought to be secondary to impaired reticuloendothelial system function. However, this has not been demonstrated clinically. Since transient bacteremia occurs following toothbrushing, we hypothesized that subjects with cirrhosis would have impaired bacterial clearance following toothbrushing compared with subjects with pulmonary disease and healthy controls. After baseline blood was drawn, the subjects underwent a dental examination to determine plaque index and gingival index. Following toothbrushing, blood was drawn at 30 seconds, 5 minutes, and 15 minutes. Bacteremia was measured using quantitative real‐time PCR with primers that amplify all known bacteria. We found greater than 75% incidence of bacteremia following toothbrushing. While control and pulmonary subjects were able to clear this bacteremia, subjects with cirrhosis had prolonged bacteremia. Baseline and peak bacterial load correlated with plaque index, suggesting that dental hygiene predicts the degree of bacteremia. However, only the severity of cirrhosis was predictive of bacterial clearance at 15 minutes, suggesting that liver function is important in clearing bacteremia. In this study, we demonstrate clinically that cirrhosis results in impaired bacterial clearance. This suggests that cirrhotic patients may be more susceptible to sepsis because of ineffective bacterial clearance.

infection

bacteria

sepsis

cirrhosis

periodontal disease

Details

Title: Subtitle: Chronic Liver Disease Impairs Bacterial Clearance in a Human Model of Induced Bacteremia
Creators: Alix Ashare - Department of Internal Medicine
Clark Stanford - University of bwa College of Dentistry, Iowa City, Iowa, USA
Patricia Hancock - University of bwa College of Dentistry, Iowa City, Iowa, USA
Donna Stark - University of bwa College of Dentistry, Iowa City, Iowa, USA
Kathleen Lilli - Department of Internal Medicine
Emily Birrer - Department of Internal Medicine
Amanda Nymon - Department of Internal Medicine
Kevin C Doerschug - Department of Internal Medicine
Gary W Hunninghake - Department of Internal Medicine
Resource Type: Journal article
Publication Details: Clinical and translational science, Vol.2(3), pp.199-205
DOI: 10.1111/j.1752-8062.2009.00122.x
PMID: 20443893
PMCID: PMC3415466
NLM abbreviation: Clin Transl Sci
ISSN: 1752-8054
eISSN: 1752-8062
Publisher: Blackwell Publishing Inc
Language: English
Date published: 06/2009
Academic Unit: Pulmonary, Critical Care, and Occupational Medicine; Dentistry Administration; Prosthodontics; Orthopedics and Rehabilitation; Craniofacial Anomalies Research Center; Internal Medicine
Record Identifier: 9984094878602771

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