A particularly important role is played by the reduced RES activity, due to the presence of extrahepatic and intrahepatic shunts through sinusoids without Kupffer cells, reduced number of Kupffer cells, and impaired Kupffer cell function. ...cirrhotics with impaired RES phagocytic activity (as assessed by elimination of 99 m technetium-sulphur colloid) develop acute bacterial infections more frequently than cirrhotics with normal RES phagocytic activity. 2 Both community and hospital acquired bacterial infections are frequently diagnosed in cirrhotics, most frequently spontaneous bacterial peritonitis (SBP), urinary tract infections, pneumonia, and skin infections. 3 Their incidence rises with worsening liver function. 3 Importantly, half of these episodes are asymptomatic. 1 Recently, bacterial infections and/or endotoxaemia have been associated with failure to control variceal bleeding, 4 more early variceal rebleeding, 5 abnormalities in coagulation, 6, 7 vasodilatation of the systemic vasculature, 8 and worsening liver function. 9 There has also been increased recognition that bacterial infections are involved in several pathophysiological abnormalities in cirrhosis.