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

  • Lukas Otero Sanchez
  • Thierry GustotEmail author
Management of Cirrhotic Patient (A Cardenas and P Tandon, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Management of the Cirrhotic Patient


Purpose of Review

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.

Recent Findings

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.


Cirrhosis Bacterial infection Multidrug-resistant organism Antibiotic Carbapenem Glycopeptide 



amoxicillin-clavulanic acid


acute-on-chronic liver failure


acute kidney injury


carbapenem-resistant Enterobacteriaceae


extended-spectrum β-lactamase


Gram-negative bacillus


Gram-positive coccus




hepatorenal syndrome


intensive care unit


multidrug-resistant organism


methicillin-resistant Staphylococcus aureus


methicillin-susceptible Staphylococcus aureus




randomized controlled trial


spontaneous bacteremia


spontaneous bacterial peritonitis


third-generation cephalosporins


urinary tract infection


vancomycin-susceptible Enterococcus


vancomycin-resistant Enterococcus


extensively drug-resistant



The authors acknowledge the contribution of a medical writer, Sandy Field, PhD, to the preparation of this paper.

Author’s Contributions

Lukas Otero Sanchez and Thierry Gustot designed the manuscript. Lukas Otero Sanchez wrote the first draft, and Thierry Gustot provided feedback. The final draft was accepted by all authors.

Compliance with Ethical Standards

Conflicts of Interest

Thierry Gustot reports grants from Promethera Biosciences and grants from Martin Pharmaceuticals, outside the submitted work. Lukas Otero Sanchez has nothing to disclose.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Authors and Affiliations

  1. 1.Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
  2. 2.Laboratory of Experimental GastroenterologyUniversité Libre de BruxellesBrusselsBelgium
  3. 3.Inserm Unité 1149Centre de Recherche sur l’inflammation (CRI)ParisFrance
  4. 4.UMR S_1149Université Paris DiderotParisFrance
  5. 5.The EASL-CLIF ConsortiumEuropean Foundation-CLIFBarcelonaSpain

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