Multidrug-Resistant Bacterial Infection in Patients with Cirrhosis. A Review

Abstract

The burden of multidrug resistance has become one of the world’s most urgent public health problems. Patients with infection caused by multidrug-resistant organisms (MDROs) have an increased risk for worse outcomes and death. Cirrhotic patients, mostly decompensated, are prone to developing infections caused by MDROs, particularly because they are in close contact with healthcare settings. During the last two decades, the first-line therapies recommended to treat infections in cirrhotic patients have become progressively less effective. Early identification of patients at high risk of MDRO infection is essential. Considering the emergence and spread of MDROs, empirical first-line antibiotic treatment must be tailored according to the local prevalence of MDROs and risk factors for MDRO infection. New empirical strategies must include antibiotics that are active against MDROs followed by a well-standardized early de-escalation policy. Appropriate use of broad-spectrum antibiotics, restriction of antibiotic prophylaxis to high-risk populations, promotion of infection-control measures, and support of research into the development of new antibiotics are needed to control the worrisome spread of MDROs.