title: The new epidemiology of nosocomial bacterial infections in cirrhosis: therapeutical implications.
abstract: Cirrhotic patients are at increased risk of developing infection, sepsis and death. Enterobacteriaceae and nonenterococcal streptococci are the main bacteria responsible for spontaneous and urinary infections in this population. Prompt and appropriate treatment is basic in the management of cirrhotic patients with infection. Third-generation cephalosporins continue to be the gold-standard antibiotic treatment of the majority of infections acquired in the community because responsible strains are usually susceptible to β-lactams. By contrary, nosocomial infections are nowadays frequently caused by multiresistant bacteria (extended-spectrum β-lactamase-producing Enterobacteriaceae, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci among others) that are nonsusceptible to the main antibiotics. Treatment of these infections requires the use of broader spectrum antibiotics (carbapenems) or of antibiotics that are active against specific resistant bacteria (glycopeptides, linezolid, daptomycin, amikacin and colistin). Empirical antibiotic schedules must be adapted to the local epidemiological pattern of antibiotic resistance. Careful restriction of antibiotic prophylaxis to the high-risk population is also mandatory to reduce the spread of multiresistant bacteria in cirrhosis.
authors.affiliation: Liver Unit, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Catalunya, Spain.|Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.|Hospital Sant Jaume de Calella, Calella, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Acevedo
authors.affiliation: Liver Unit, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Catalunya, Spain.|Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors.forename: Aníbal
authors.initials: A
authors.lastname: Silva
authors.affiliation: Liver Unit, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Catalunya, Spain.|Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors.forename: Verónica
authors.initials: V
authors.lastname: Prado
authors.affiliation: Liver Unit, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Catalunya, Spain. jfdez@clinic.ub.es.|Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Barcelona, Spain. jfdez@clinic.ub.es.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain. jfdez@clinic.ub.es.
authors.forename: Javier
authors.initials: J
authors.lastname: Fernández
keywords: Liver cirrhosis; Multiresistant bacteria; Nosocomial infection