A patient with cirrhosis is susceptible to serious bacterial infections. Fernandez et al identified risk factors for infection by multi-resistant bacteria in patients with cirrhosis. The authors are from the University of Barcelona and other hospitals in Barcelona, Spain.


Patient selection: hospitalized patients with cirrhosis


A cirrhotic may develop infections with:

(1) Pseudomonas aeruginosa

(2) methicillin-resistant Staphylococcus aureus (MRSA)

(3) extended-spectrum beta-lactamase producing Enterobacteriaceae

(4) Enterococcus faecium


A cirrhotic patient with a multi-drug resistant bacteria was more likely to have septic shock and/or to die.


Risk factors for multi-drug resistant bacteria:

(1) nosocomial origin for the infection (developed after the first 48 hours in the hospital)

(2) long-term prophylaxis with norfloxacin

(3) recent therapy with a beta-lactam antibiotic

(4) recent infection with a multi-drug resistant bacteria


Common empiric antibiotic regimens are often ineffective in treating a cirrhotic patient with a multi-drug resistant bacteria.


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