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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Clinical impact of multidrug-resistant organisms in liver cirrhosis: A retrospective cohort study in the intensive care setting
Iva Kosuta, Jaksa Babel, Viktor Domislovic, Frano Susak, Laura Peretin, Dijana Varda Brkic, Ivana Marekovic, Radovan Radonic, Anna Mrzljak
Iva Kosuta, Jaksa Babel, Frano Susak, Radovan Radonic, Division of Intensive Care, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Iva Kosuta, Viktor Domislovic, Anna Mrzljak, Liver Transplant Unit, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Viktor Domislovic, Anna Mrzljak, Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Laura Peretin, Division of Gastroenterology, Department of Internal Medicine, General Hospital Varaždin, Varaždin 42000, Croatia
Dijana Varda Brkic, Ivana Marekovic, Department of Clinical Microbiology, Infection Prevention and Control, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Ivana Marekovic, Anna Mrzljak, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Author contributions: Kosuta I drafted the manuscript; Kosuta I and Babel J conceptualized the study and developed the methodology; Kosuta I, Babel J, Domislovic V, Susak F, and Peretin L retrieved data; Varda Brkic D, Marekovic I, Radonic R, and Mrzljak A provided critical appraisal; Marekovic I, Radonic R, and Mrzljak A contributed to the final version and supervised the study.
Institutional review board statement: The study was approved by the Institutional Review Board of the University Hospital Centre Zagreb (Approval No: 02/013 AG).
Informed consent statement: Waived due to the retrospective non-interventional nature of the research.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Deidentified data supporting the findings of this study are available from the corresponding author upon reasonable request and with institutional approval.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Iva Kosuta, MD, PhD, Consultant, Division of Intensive Care, Depart
ment of Internal Medicine, University Hospital Centre Zagreb, Ulica Mije Kispatica 12, Zagreb 10000, Croatia.
ivakosuta@gmail.com
Received: June 26, 2025
Revised: July 25, 2025
Accepted: September 15, 2025
Published online: October 21, 2025
Processing time: 117 Days and 11 Hours
BACKGROUND
Colonization with multidrug-resistant organisms (MDROs) is frequently observed in critically ill patients with liver cirrhosis admitted to intensive care units (ICUs). However, whether colonization directly leads to infections or adversely impacts clinical outcomes remains unclear. Clarifying this relationship may help determine the prognostic significance of colonization in these patients.
AIM
To evaluate the clinical relevance of MDRO colonization and infection at ICU admission in patients with cirrhosis.
METHODS
This retrospective single-center cohort study included 107 ICU admissions of patients with liver cirrhosis at a tertiary care center (2018-2024). Colonization was assessed by rectal and nasal/pharyngeal swabs within 48 hours of ICU admission. Outcomes analyzed included MDRO infection during ICU stay, concordance between colonizing and infecting strains, organ support requirements, and 28-day transplant free survival. Multivariable logistic regression and Kaplan-Meier analyses were used to evaluate predictors of infection and mortality.
RESULTS
Nearly one-third (29.9%) of patients were colonized with MDROs on admission, more commonly in the acute-on-chronic liver failure phenotype than those with acute decompensation (34.5 vs 10.0%, P = 0.033). Although infections were established in the majority (85%) of cases, of which 17.6% due to MDROs, colonization alone did not independently predict these infections [odds ratio (OR) = 2.18, P = 0.383] nor influenced short-term mortality (OR = 1.14, P = 0.813). However, once MDRO infection occurred, an 82% concordance was observed between colonizing and infecting strains. MDRO infections, unlike colonization, significantly increased the need for organ-support interventions, including mechanical ventilation and vasopressor therapy and prolonged ICU stays. Only severity of organ dysfunction, quantified by the Sequential Organ Failure Assessment score, independently predicted 28-day mortality (OR = 1.38, P = 0.024).
CONCLUSION
MDRO colonization at ICU admission is frequent among critically ill patients with cirrhosis, particularly those with acute-on-chronic liver failure. While colonization alone does not predict infection or early mortality, its clinical value emerges in guiding empirical antibiotic treatment once infection is suspected. Ultimately, short-term survival appears to be more strongly influenced by the severity of organ failure than by either MDRO colonization or infection.
Core Tip: This retrospective intensive care unit cohort study evaluated the impact of multidrug-resistant colonization in patients with liver cirrhosis. While colonization was common, especially in those with acute-on-chronic liver failure, it was not independently linked to infection or short-term mortality. However, high concordance between colonizing and infecting strains supports its role in guiding empirical antibiotic therapy once infection is suspected. These findings highlight the importance of early screening, local resistance data, and tailored empirical treatment to improve outcomes of critically ill patients with cirrhosis.
