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The extensive use of invasive procedures and of long-term norfloxacin prophylaxis in the management of cirrhotic patients may have influenced the epidemiology of bacterial infections in cirrhosis. We conducted a prospective evaluation of all bacterial infections diagnosed in patients with cirrhosis in a Liver Unit between April 1998 and April 2000. A total of 405 patients presented 572 bacterial infections in 507 admissions. Spontaneous bacterial peritonitis was the most frequent infection (138 cases). Gram-positive cocci were responsible for 53% of total bacterial infections in the study, being the main bacteria isolated in nosocomial infections (59%). Patients requiring treatment in an intensive care unit and those submitted to invasive procedures presented a higher rate of infections caused by grampositive cocci (77% vs. 48%, P < .001 and 58% vs. 40%, P < .02, respectively). B acterial infection is one of the most important clinical problems in patients with decompensated cirrhosis. It is present at admission or develops during hospitalization in 20% to 60% of the patients. 1-8 On the other hand, it is a common cause of death. Most studies assessing the etiology and clinical types of bacterial infections in cirrhosis were performed in the 1980s. At that time, the most common infections were urinary tract infections, pneumonia, and spontaneous bacterial peritonitis (SBP); most infections were community acquired; and approximately 70% to 80% of the isolated organisms were gram-negative bacilli (GNB). 1-8 However, during the last decade practice in hepatology has considerably changed and this may have influenced the epidemiology of bacterial infections in liver diseases. Treatment of cirrhotic patients with severe complications in intensive care units has been generalized, particularly with the extension of the liver transplantation programs, and the invasive procedures used in this setting are frequently associated with iatrogenic complications including infections. 9 On the other hand, new invasive treatments have been developed and are extensively used for specific complications of cirrhosis, including variceal ligation, transjugular intrahepatic portosystemic shunt, and arterial embolization or percutaneous ablation of hepatocellular carcinoma. These treatments may be also associated with infections. Finally, long-term selective intestinal decontamination with norfloxacin, which was introduced in 1987, is now widely used for the primary and secondary prophylaxis of SBP and spontaneous bacteremia in cirrhosis. 10,11 Norfloxacin prevents infections caused by GNB but not those caused by gram-positive cocci (GPC). All these features may have changed the type and etiology of acute bacterial infections in cirrhosis. However, there is no study on this topic.Another relevant problem, which has not been adequately evaluated is the clinical relevance of infections caused by quinoloneresistant gram-negative bacilli (QR-GNB) in cirrhosis. It is well known that patients submitted to long-term selective intestinal deconta...

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