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Management of multidrug-resistant infections in cirrhosis

Research output: Contribution to journalArticlepeer-review

Charles E Gallaher, Debbie L Shawcross

Original languageEnglish
Pages (from-to)173-187
Number of pages15
JournalSeminars in Liver Disease
Volume42
Issue number2
Early online date7 Feb 2022
DOIs
Accepted/In press4 Jan 2022
E-pub ahead of print7 Feb 2022
Published1 May 2022

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Publisher Copyright: © 2022 Thieme Medical Publishers, Inc.. All rights reserved.

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Abstract

The World Health Organization describes antimicrobial resistance as one of the biggest threats to global health, food security, and development with indiscriminate use of antimicrobials globally driving the emergence of multidrug-resistant bacteria, resistant to 60% of antimicrobials in some countries. Infections with multidrug-resistant organisms (MDROs) have increased in recent decades in patients with cirrhosis, who are frequently prescribed antibiotics, regularly undergo invasive procedures such as large volume paracentesis, and have recurrent hospitalizations, posing a particular risk in this already immunocompromised cohort of patients. In this review, we explore mechanisms underlying this vulnerability to MDRO infection; the effect of bacterial infections on disease course in cirrhosis; prevalence of MDROs in patients with cirrhosis; outcomes following MDRO infection; fungal infections; antibiotics and their efficacy; and management of MDRO infections in terms of detection, antimicrobial and nonantimicrobial treatments, prophylaxis, antibiotic stewardship, the gut microbiome, and technological interventions.

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