title: New antibiotic strategies in patients with cirrhosis and bacterial infection.
abstract: Early diagnosis and adequate empirical antibiotic treatment of bacterial infections in advanced cirrhosis is essential to improve outcomes given the high risk of developing severe sepsis, multiple organ failure and death. β-lactams and quinolones are nowadays frequently ineffective in nosocomial and healthcare associated infections, due to the increasing prevalence of multidrug resistant (MDR) bacteria reported across different geographical areas. Recent antibiotic exposure also increases the risk of developing MDR bacterial infections. Initial antibiotic strategies should therefore be tailored according to the presence or absence of risk factors of MDR bacteria and to the severity of infection and should consider the local epidemiology. Empirical treatment in the population at high risk of MDR bacterial infections requires the use of broad-spectrum antibiotics (carbapenems or tigecycline) and of drugs active against specific resistant bacteria (glycopeptides, linezolid, daptomycin, amikacin, colistin). Early de-escalation policies are recommended to prevent the spread of MDR bacteria in cirrhosis.
authors.affiliation: a Liver Unit, Hospital Clínic Barcelona , University of Barcelona , Barcelona, Spain.|b Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS).|c Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED).
authors.forename: Javier
authors.initials: J
authors.lastname: Fernández
authors.affiliation: d The South West Liver Unit , Plymouth Hospital , Plymouth, UK.
authors.forename: Juan
authors.initials: J
authors.lastname: Acevedo
mesh_terms: D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D055624:Methicillin-Resistant Staphylococcus aureus; D015995:Prevalence; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D011550:Pseudomonas aeruginosa; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D065507:Vancomycin-Resistant Enterococci
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic strategies; multidrug resistant bacteria; prognosis; survival