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

Table 2 Suggested empirical antibiotic therapy of bacterial infections in cirrhosis

Type of infection	Community-acquired infections	Nosocomial and HCA1 infections	Local epidemiological pattern
SBP, SBE and SB	Third generation cephalosporin	Piperacilin/tazobactam	Low prevalence of MR bacteria
	Or amoxicillin/clavulanic acid	Or carbapenem	ESBL-E
		Plus glycopeptides (or linezolid)	MRSA and VSE (when VRE)
Urinary tract infections	Third generation cephalosporin	Without sepsis:	VSE
	Or amoxicillin/clavulanic acid	Nitrofurantoin or fosfomycin
		With sepsis:	Low prevalence of MR bacteria
		Piperacilin/tazobactam
		Or carbapenem	ESBL-E
		Or plus glycopeptides (or linezolid)	MRSA and VSE (when VRE)
Pneumonia	Amoxicillin/clavulanic acid	Piperacilin/tazobactam	Low prevalence of MR bacteria
	Or ceftriaxone + macrolide	Meropenem or ceftazidime + ciprofloxacin	ESBL-E and P. aeruginosa
	Or levofloxacin	Plus vancomycin (or linezolid)	MRSA and VSE (when VRE)
	Or moxifloxacin
Skin and soft tissue infections	Amoxicillin/clavulanic acid	Meropenem or ceftazidime + oxacillin	ESBL-E and P. aeruginosa
	Or third generation cephalosporin plus oxacillin	Plus glycopeptides (or linezolid or daptomycin)	MRSA and VSE (when VRE)

¹HCA infections with at least two of the following risk factors for MR bacteria: long-term norfloxacin prophylaxis, recent infection by MR bacteria in the last 6 mo, recent use of β-lactams in the last 3 mo. SBP: Spontaneous bacterial peritonitis; SBE: Spontaneous bacterial empyema; SB: Spontaneous bacteremia; HCA: Health-care associated; ESBL-E: Extended-spectrum β-lactamase producing Enterobacteriaceae; MRSA: Methicillin-resistant Staphylococcus aureus; VSE: Vancomycin-susceptible Enterococcus; VRE: Vancomycin resistant Enterococcus.