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

Table 3 Recommended empirical antibiotic treatment for bacterial infection in cirrhosis

Type of infection	Community-acquired infection	Nosocomial and HCA infection or sepsis
SBP, spontaneous bacterial empyema and spontaneous bacteremia	Cefotaxime or Amoxicilin/clavulanic acid	Piperacillin/tazobactam or Meropenem ± Vancomycin or Daptomycin or Linezolid1
UTI	Fosfomycin or cotrimoxazole	Uncomplicated: Nitrofurantoin or Fosfomycin; if sepsis: Piperacillin/tazobactam or Meropenem ± Glycopeptide
Pneumonia	Amoxicilin/clavulanic acid; Ceftriaxone + Macrolide; Levofloxacin; Moxifloxacin	Piperacillin/tazobactam or Meropenem or Ceftazidime + Ciprofloxacin; Glycopeptides or Linezolid1 should be added in patients with risk factors for MRSA2
Skin and soft tissue infections	Amoxicilin/clavulanic acidor ± Clindamycin	Meropenem or Piperacillin/tazobactam + Glycopeptide or Daptomycin or Linezolid1 ± Cindamycin; if necrotizing fascitis: Meropenem + Daptomycin + Clindamycin

¹Vancomycin, teicoplanin or daptomycin in areas with a high prevalence Methicillin-resistant Staphylococcus aureus and vancomycin-susceptible enterococci. Vancomycin must be replaced by linezolid in areas with a high prevalence of vancomycin-resistant enterococci.

²Ventilator-associated pneumonia, previous antibiotic therapy, nasal Methicillin-resistant Staphylococcus aureus carriage.

HCA: Health care associated; MRSA: Methicillin-resistant Staphylococcus aureus; SBP: Spontaneous bacterial peritonitis; UTI: Urinary tract infection.