Published online Mar 27, 2023. doi: 10.4254/wjh.v15.i3.377
Peer-review started: November 12, 2022
First decision: November 23, 2022
Revised: December 28, 2022
Accepted: March 10, 2023
Article in press: March 10, 2023
Published online: March 27, 2023
Processing time: 130 Days and 10.7 Hours
There is abundant evidence that bacterial infections are severe complications in patients with cirrhosis, being the most frequent trigger of acute-on-chronic liver failure and causing death in one of every four patients during hospitalization. For these reasons, early diagnosis and effective treatment of infections are mandatory to improve patient outcomes. However, treating physicians are challenged in daily practice since diagnosing bacterial infections is not always straightforward. This situation might lead to delayed antibiotic initiation or prescription of ineffective regimens, which are associated with poor outcomes. On the other hand, prescribing broad-spectrum antibiotics to all patients suspected of bacterial infections might favor bacterial resistance development. This is a significant concern given the alarming number of infections caused by multidrug-resistant microorganisms worldwide. Therefore, it is paramount to know the local epidemiology to propose tailored guidelines for empirical antibiotic selection in patients with cirrhosis in whom bacterial infections are suspected or confirmed. In this article, we will revise current knowledge in this area and highlight the importance of surveillance programs.
Core Tip: Practitioners who participate in caring for patients with cirrhosis are challenged when using antibiotics rationally. On one side, bacterial infections are frequent, severe, and not always straightforward to diagnose; on the other, scant granular data is publicly available about the causal microorganisms and their susceptibility patterns. According to experts, empiric antibiotic treatments should cover 80% of the common pathogens in stable patients and 90% in critically ill patients with suspected infections. Therefore, it is necessary to know the microorganisms expected to be involved in the most frequent bacterial infections and their susceptibility patterns to develop evidence-based guidelines. This opens a window of opportunity for research because bacterial infections and multidrug resistance are global health issues expected to grow over the following decades.