Impact of multidrug resistance on the management of bacterial infections in cirrhosis

Table 1 Prevalence and prognosis of multidrug-resistant organisms infections in cirrhosis

Ref.	Study design	n	MDR infection (%)	Mortality (%)	Comments
Piano et al[7]	Single center study	75	35.0	86.0	ACLF grade 2 and 3 were more frequent in MDRO infected patients
Cassini et al[3]	Meta-analysis	671 689	NA	4.9	Estimate the incidence of infections caused by selected antibiotic-resistant bactéria in countries of the EU and EEA in 2015
Trebicka et al[9]	European multicenter	376	18.9	40.8 at 28.0 d; 48.7 at 90.0 d	In infection-induced ACLF, the prevalence of MDR strains was significantly higher; severe sepsis (40.7% vs 21.6%), ACLF (72.3% vs 42.0%) and 90-d mortality (48.7% vs 30.7%) were more frequent in infections caused by MDR strains compared to non-MDR strains
Costabeber et al[17]	Retrospective	474	37.5	-	To evaluate the resistance profile of bacteria isolated from cirrhotic patients admitted to a referral hospital in Brazil
Trebicka et al[9]	European multicenter	520	14.8	35.1 at 28.0 d	MDROs were not significantly different between specific infections in the different European regions; MDROs were more frequently isolated in the ICU (23.8% vs 12.2%) and nosocomial infections (21.3% vs 8.3% and 6.6% in CA and HCA infections, respectively); MDROs were more prevalent in infections causing severe sepsis/shock (30.3% vs 12.2%) or ACLF (20.5% vs 9.4%)
Johnson et al[18]	Retrospective	3951	5.6	27.7	Presence of MDR bacteria in the blood was not associated with in-hospital mortality

ACLF: Acute on chronic liver failure; EU: European Union; EEA: European Economic Area; MDR: Multi-drug resistant; MDRO: Multi drug resistant organism; ICU: Intensive care unit; CA: Community acquired; HCA: Health-care associated; NA: Not available.