Multiresistant bacterial infections in liver cirrhosis: Clinical impact and new empirical antibiotic treatment policies

Abstract

Recently, important changes have been reported regarding the epidemiology of bacterial infections in liver cirrhosis. There is an emergence of multiresistant bacteria in many European countries and also worldwide, including the United States and South Korea. The classic empirical antibiotic treatment (third-generation cephalosporins, e.g. , ceftriaxone, cefotaxime or amoxicillin-clavulanic acid) is still effective in infections acquired in the community, but its failure rate in hospital acquired infections and in some health-care associated infections is high enough to ban its use in these settings. The current editorial focuses on the different epidemiology of bacterial infections in cirrhosis across countries and on its therapeutic implications.

Nosocomial spontaneous bacterial peritonitis antibiotic treatment in the era of multi-drug resistance pathogens: A systematic review

“…Possible reasons for this phenomenon were the large preventive use of quinolones and the growing degree of instrumentalization of the cirrhotic patient, especially in the nosocomial context[35]. …”

Spontaneous bacterial and fungal peritonitis in patients with liver cirrhosis: A literature review

“…Recently, extensively drug-resistant (XDR) bacteria such as carbapenemase-producing Klebsiella pneumoniae and vancomycin-resistant Enterococci have been isolated from patients with LC[ 31 ]. The development of MDR infections is associated with suboptimal antibiotic use including antibiotic prophylaxis, nosocomial infection, recent infection with an MDR organism, current or recent hospitalization, exposure while receiving health care, and upper gastrointestinal bleeding in LC[ 33 , 34 ]. In a large prospective study, MDR bacteria were isolated in 4% of community-acquired infections, 14% of health care-associated infections, and 35% of nosocomial infections[ 33 ].…”

Current concepts and future strategies in the antimicrobial therapy of emerging Gram-positive spontaneous bacterial peritonitis

“…However, over the last decade the prevalence of Gram-positive bacteria (GPB) and multidrug resistant (MDR) SBP has increased worryingly[ 6 ]. Important driving factors for this epidemiological change have been the extensive use of quinolones, as a prophylactic measure, and the increasing degree of instrumentalization of patients suffering from cirrhosis[ 7 ]. Consequently, empirical therapy based on third-generation cephalosporins (3GCs) or amoxicillin/clavulanic acid, especially within a healthcare setting, can no longer be considered the standard of care due to poor outcomes[ 8 ].…”