• Cirrhosis
• blood stream infection
• infections
• peritonitis
• resistance

• Humans
• Anti-Bacterial Agents/therapeutic use
• Anti-Bacterial Agents/adverse effects
• Antimicrobial Stewardship
• Bacterial Infections/drug therapy
• Bacterial Infections/microbiology
• Liver Cirrhosis/drug therapy
• Liver Cirrhosis/complications
• Risk Factors
• Antibiotic Prophylaxis
• Drug Administration Schedule
• Time Factors
• Treatment Outcome
• Drug Resistance, Multiple, Bacterial

• infections
• antibiotic resistance
• liver transplant
• fluoroquinolones
• trimethoprim-sulfomethoxazole

• UM1TR004360 NCATS NIH HHS
• 2I01CX001076 U.S. Department of Veterans Affairs
• I01 CX001076 CSRD VA
• UM1 TR004360 NCATS NIH HHS
• R01 AA029398 NIAAA NIH HHS
• I01 CX002472 CSRD VA
• I01CX002472 U.S. Department of Veterans Affairs

• Acute-on-chronic liver failure
• Albumin
• Antibiotic
• Bacterial infection
• Multidrug-resistant bacteria
• Spontaneoous bacterial peritonitis
• systemic inflammation

• Deduplicate
• Detection rates
• Different specimens
• Implications
• MDRO

• Humans
• Drug Resistance, Multiple, Bacterial
• Cross Infection/microbiology
• Cross Infection/epidemiology
• Klebsiella pneumoniae/genetics
• Klebsiella pneumoniae/isolation & purification
• Klebsiella pneumoniae/drug effects
• Sputum/microbiology
• Methicillin-Resistant Staphylococcus aureus/isolation & purification
• Methicillin-Resistant Staphylococcus aureus/genetics
• Acinetobacter baumannii/drug effects
• Acinetobacter baumannii/isolation & purification
• Acinetobacter baumannii/genetics
• Anti-Bacterial Agents/pharmacology
• Pseudomonas aeruginosa/drug effects
• Pseudomonas aeruginosa/isolation & purification
• Pseudomonas aeruginosa/genetics
• Bronchoalveolar Lavage Fluid/microbiology
• Carbapenems/pharmacology
• Escherichia coli/isolation & purification
• Escherichia coli/drug effects
• Escherichia coli/genetics
• Epidemiological Monitoring
• Hospitals

• JSTJ-2023-WJ006 Jiangsu Provincial Association for Science and Technology Young Science and Technology Talent Support Project (Health Field)
• JSYGY-3-2023-559 Jiangsu Province Hospital Management Innovation Research Project
• NDYG2023039 Project of Chinese Hospital Reform and Development Institute, Nanjing University
• YNRCQN0314 The third Outstanding Young and Middle-aged Talents Training Program of Jiangsu Provincial People's Hospital
• PY2022017 Young Scholars Fostering Fund of the First Affiliated Hospital of Nanjing Medical University
• The third Outstanding Young and Middle-aged Talents Training Program of Jiangsu Provincial People’s Hospital

• Humans
• Terlipressin/adverse effects
• Drug Resistance, Multiple, Bacterial/genetics
• Anti-Bacterial Agents/adverse effects
• Risk Factors
• Liver Cirrhosis/drug therapy
• Bacteria

• DECISION (project ID 847949) the European Union's Horizon 2020 research and innovation program
• GALAXY (project ID 668031) the European Union's Horizon 2020 research and innovation program
• IHMCSA (project ID 964590) the European Union's Horizon 2020 research and innovation program
• LIVERHOPE (project ID 731875) the European Union's Horizon 2020 research and innovation program
• MICROB-PREDICT (project ID 825694) the European Union's Horizon 2020 research and innovation program
• ACLF-I cluster Hessian Ministry of Higher Education, Research and the Arts (HMWK)
• DEEP-HCC German Federal Ministry of Education and Research (BMBF)
• 403224013-SFB 1382 (A09) Deutsche Forschungsgemeinschaft

• Humans
• Rifaximin/therapeutic use
• Rifampin/pharmacology
• Rifampin/therapeutic use
• Coagulase
• Staphylococcus
• Anti-Bacterial Agents/pharmacology
• Anti-Bacterial Agents/therapeutic use

• Humans
• Ascites/etiology
• Ascites/therapy
• Asia/epidemiology
• Liver Diseases/complications
• Liver Diseases/therapy

• Acute-on-chronic liver failure
• Ascites
• Cirrhosis
• Elastography
• HVPG
• Hepatorenal syndrome
• Portal vein thrombosis
• Spontaneous bacterial peritonitis
• Transjugular intrahepatic portosystemic shunt
• Variceal bleeding
• Varices

• Humans
• Trimethoprim, Sulfamethoxazole Drug Combination
• Anti-Bacterial Agents/therapeutic use
• Anti-Bacterial Agents/pharmacology
• Escherichia coli
• Escherichia coli Infections
• Veterans Health
• Drug Resistance, Bacterial
• Ciprofloxacin/therapeutic use
• Fluoroquinolones/therapeutic use
• Klebsiella pneumoniae
• Peritonitis/drug therapy
• Antibiotic Prophylaxis

• Albumin
• Ascites
• Cirrhosis
• Gastroenterology
• Spontaneous bacterial peritonitis

To analyze the infection and distribution of multidrug-resistant organisms (MDRO) in different clinical specimens, thereby providing a reference for clinical diagnosis and treatment and prevention and control.

2314 strains of MDRO isolated from clinical specimens in the First Affiliated Hospital of Nanjing Medical University from January to December 2020. MDRO were collected by Information System. The detection rate of MDRO, infection rate, the proportion of infection, and detection rate of MDRO infection in different specimens were analyzed.

The top three specimens in the detection rate of MDRO were BALF (60.71%), sputum (33.68%), and blood (28.79%). The top three specimens in the proportion of MDRO infection were blood (97.74), other sterile body fluids (90.35%), and BALF (90.20%). The top three specimens in the MDRO infection rate were BALF (9.75%), sputum (3.07%), and secretions (2.90%). The top three specimens in the detection rate of MDRO infection were sputum (0.63‰), other sterile body fluids (0.13‰), and secretions (0.11‰).

The detection and infection distribution of MDRO vary greatly in different specimens. The submission of sterile body fluids for examination should be strengthened and the standard of sample collection should be highlighted.

• MDRO
• detection rate
• different specimens
• infection
• sterile body fluids

Refractory ascites (RA) is a frequent and life-threatening complication of cirrhosis. In selected patients with RA, transjugular intrahepatic portosystemic shunt (TIPS) placement and liver transplantation (LT) are currently considered the best therapeutic alternatives to repeated large volume paracentesis. In patients with a contraindication to TIPS or LT, the alfapump^® system (Sequana Medical, Ghent, Belgium) has been developed to reduce the need for iterative paracentesis, and consequently to improve the quality of life and nutritional status. We report here recent data on technical progress made since the first implantation, the efficacy and tolerance of the device, the position of the pump in the therapeutic arsenal for refractory ascites, and the grey areas that remain to be clarified regarding the optimal selection of patients who are potential candidates for this treatment.

• Alfapump
• Refractory ascites
• Automated low flow ascites pump
• Cirrhosis
• Liver

• SARS-CoV-2
• cholangiopathy
• cirrhosis
• intensive care unit
• multidrug resistance

The efficacy of antibiotic prophylaxis to prevent rebleeding or infection after variceal bleeding in patients with liver cirrhosis colonized with multidrug-resistant organisms (MDROs) is unknown.

In this retrospective study, patients with liver cirrhosis and endoscopically confirmed variceal bleeding who were treated at a tertiary care center in Germany and were screened for MDROs at the time of bleeding were eligible for inclusion. Efficacy of antibiotic prophylaxis was evaluated in patients stratified according to microbiological susceptibility testing.

From 97 patients, the majority had decompensated liver cirrhosis (median MELD Score 17) and ACLF was present in half of the patients (47.4%). One third of patients were colonized with MDRO at baseline. De-novo infection until day 10 or the combination of de-novo infection or rebleeding were comparable among both groups (p = 0.696 and p = 0.928, log-rank-test). Risk of de-novo infection or rebleeding was not significantly increased in patients who received antibiotic prophylaxis that did not cover the MDRO found upon baseline screening. Acute-on-chronic liver failure at baseline was the strongest and only independent risk factor that was associated with both outcomes (OR 5.52, 95%-CI 1.48–20.61, p = 0.011 and OR 11.5, 95%-CI 2.70–48.62, p<0.001). Neither MDRO colonization at baseline nor covering all detected MDRO with antibiotic prophylaxis (i.e. “adequate” prophylaxis) impacted transplant-free survival. Again, the presence of ACLF was the strongest independent risk factor associated with mortality (OR 9.85, 95%-CI 3.58–27.12, p<0.0001).

In this study, MDRO colonization did not increase the risk of rebleeding, infections nor death, even if antibiotic prophylaxis administered did not cover all MDRO detected at MDRO screening. Patients with ACLF had an increased risk of bleeding, infections and death.

• Antibiotic Prophylaxis
• Drug Resistance, Multiple, Bacterial
• Esophageal and Gastric Varices/complications
• Esophageal and Gastric Varices/drug therapy
• Gastrointestinal Hemorrhage/complications
• Gastrointestinal Hemorrhage/prevention & control
• Humans
• Liver Cirrhosis/drug therapy
• Retrospective Studies

Enrofloxacin (EFX) reacting with Ca(II) afforded a new complex, [Ca(EFX)₂(H₂O)₄] (EFX-Ca), which was structurally characterized both in solid and solution chemistry. E. coli and S. typhi were tested to be the most sensitive strains for EFX-Ca. The LD₅₀ value of EFX-Ca in mice was 7736 mg/kg, implying the coordination of EFX to Ca(II) effectively reduced its acute toxicity. EFX-Ca also decreased the plasma-binding rate and enhanced the drug distribution in rats along with longer elimination half-life. EFX-Ca also showed similar low in vivo acute toxicity and higher anti-inflammation induced by H₂O₂ or CuSO₄ in zebrafish, with reactive oxygen species (ROS)-related elimination. The therapeutic effects of EFX-Ca on two types (AA and 817) of E. coli-infected broilers were also better than those of EFX, with cure rates of 78% and 88%, respectively. EFX-Ca showed promise as a bio-safe metal-based veterinary drug with good efficacy and lower toxicity.

• AGREE II
• Bacterial infections
• Cirrhosis
• Clinical practice guideline
• Liver failure

• Anti-Bacterial Agents/therapeutic use
• Cefotaxime
• Ciprofloxacin
• Humans
• Liver Cirrhosis/complications
• Liver Cirrhosis/drug therapy
• Liver Failure

• 71904155 National Natural Science Foundation of China
• 2019ZDLSF01-05 the key research and development program in Shaanxi province of China
• 2020SF-064 the Key Research and Development Program of Shaanxi
• xzy012019079 the Fundamental Research Funds for the Central Universities

• ammonia
• cirrhosis
• fecal transplant
• lactulose
• probiotic
• rifaximin

• Fecal Microbiota Transplantation/methods
• Fecal Microbiota Transplantation/statistics & numerical data
• Hepatic Encephalopathy/drug therapy
• Host Microbial Interactions/drug effects
• Humans
• Microbiota/drug effects
• Prebiotics/administration & dosage
• Probiotics/therapeutic use

• K23 DK117055 NIDDK NIH HHS
• U01 AI124255 NIAID NIH HHS

• Antibiotic prophylaxis
• Antimicrobial resistance
• Antimicrobial stewardship
• Drug resistance
• Microbial

Bacterial infections are common in patients with decompensated liver cirrhosis and a leading cause of death. Reliable data on antibiotic resistance are required to initiate effective empiric therapy. We here aim to assess the antimicrobial resistance profile of bacteria among patients with liver cirrhosis and infection.

Overall, 666 cirrhotic patients admitted to Hannover Medical School between January 2012 and April 2018 with ascites were assessed for bacterial infection. In case of infection, bacteria cultured from microbiological specimens of ascites, blood or urine were identified and analyzed for resistances against common antibiotic agents. Furthermore, analyses compared two periods of time and community-acquired vs. nosocomial infections.

In 281 patients with infection, microbiological sampling was performed and culture-positive results were obtained in 56.9%. Multidrug-resistant (MDR)-bacteria were found in 54 patients (19.2%). Gram-positive organisms were more common (n = 141/261, 54.0%) and detected in 116/192 culture-positive infections (60.4%). Comparing infections before and after 2015, a numerical decline for MDR-bacteria (23.8% vs. 15.6%, p = 0.08) was observed with a significant decline in meropenem resistance (34.9% vs. 19.5%, p = 0.03). MDR-bacteria were more frequent in the case of nosocomial infections. Of note, in ascites the majority of the tested bacteria were resistant against ceftriaxone (73.8%) whereas significantly less were resistant against meropenem (27.0%) and vancomycin (25.9%).

In our tertiary center, distinct ratios of gram-positive infection with overall low ratios of MDR-bacteria were found. Adequate gram-positive coverage in the empiric therapy should be considered. Carbapenem treatment may be omitted even in nosocomial infection. In contrast, 3rd generation cephalosporins cannot be recommended even in community-acquired infection in our cirrhotic population.

The online version contains supplementary material available at 10.1186/s12876-021-01871-w.

• Antibiotic resistance
• Ascites
• Bacterial infection
• Liver cirrhosis
• Multiresistant bacteria

With the emergence of multidrug-resistant organisms, the efficacy of antibiotic prophylaxis to prevent spontaneous bacterial peritonitis (SBP) has been debated. The aim of this study was to assess factors impacting effectiveness of SBP prophylaxis.

We searched PubMed, Embase, and the Cochrane Registry from inception to May 2019 to identify randomized controlled trials of patients with liver cirrhosis that assessed SBP occurrence/recurrence during antibiotic prophylaxis with the common antibiotic agents. Network meta-analysis was performed, pooling data with regard to incidence rate ratios (IRRs) of SBP, death, or extraperitoneal infections.

Overall, 1,626 patients in 12 randomized controlled trials were included. During primary prophylaxis, the incidence rate of SBP and death in the norfloxacin-treated patients was 0.117 and 0.438 per patient-year, respectively, and IRRs of placebo vs norfloxacin were significantly higher (IRR 5.35, 95% confidence interval 1.99–14.38, P = 0.0009 for SBP and IRR 2.04, 95% confidence interval 1.20–3.44, P = 0.008 for death). The efficacy of norfloxacin to prevent SBP, but not death, decreased over time (annual percent change from 1992 to 2015 8.2%, P = 0.019), The positive treatment effect was lower in studies including patients with increased ascites protein (P = 0.021) or exceedingly high serum bilirubin (P = 0.012) levels. Norfloxacin was not superior to other antibiotics. The incidence rate of SBP was 2.5-fold higher in patients treated with norfloxacin as secondary compared with primary prophylaxis. No significant differences between treatment designs were observed in secondary prophylaxis.

Norfloxacin remained superior to placebo in preventing SBP, yet the efficacy to prevent SBP, not death, decreased over time. Further studies to understand this phenomenon are urgently needed.

• Bacterial abundance
• Enterobacteriaceae
• Infections
• Multidrug-resistance
• Quinolones

• Gilead Sciences
• Projekt DEAL