Bao SS, Lu Y. Multidrug-resistant organism colonization in critically ill cirrhotic patients: Marker or mediator of mortality? World J Hepatol 2026; 18(1): 114384 [DOI: 10.4254/wjh.v18.i1.114384]
Corresponding Author of This Article
Shi-San Bao, Department of Pathology, Faculty of Medicine and Health, University of Sydney, D06, Sydney 2006, New South Wales, Australia. profbao@hotmail.com
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Gastroenterology & Hepatology
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Letter to the Editor
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Jan 27, 2026 (publication date) through Jan 27, 2026
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World Journal of Hepatology
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1948-5182
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Bao SS, Lu Y. Multidrug-resistant organism colonization in critically ill cirrhotic patients: Marker or mediator of mortality? World J Hepatol 2026; 18(1): 114384 [DOI: 10.4254/wjh.v18.i1.114384]
World J Hepatol. Jan 27, 2026; 18(1): 114384 Published online Jan 27, 2026. doi: 10.4254/wjh.v18.i1.114384
Multidrug-resistant organism colonization in critically ill cirrhotic patients: Marker or mediator of mortality?
Shi-San Bao, Yan Lu
Shi-San Bao, Department of Pathology, Faculty of Medicine and Health, University of Sydney, Sydney 2006, New South Wales, Australia
Yan Lu, Department of Clinical Laboratory, Gansu Provincial Hospital of TCM, Lanzhou 730050, Gansu Province, China
Co-corresponding authors: Shi-San Bao and Yan Lu.
Author contributions: Bao SS and Lu Y drafted and revised the manuscript, and they contributed equally to this manuscript as co-corresponding authors. All authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Shi-San Bao, Department of Pathology, Faculty of Medicine and Health, University of Sydney, D06, Sydney 2006, New South Wales, Australia. profbao@hotmail.com
Received: September 17, 2025 Revised: October 1, 2025 Accepted: December 17, 2025 Published online: January 27, 2026 Processing time: 131 Days and 19.7 Hours
Abstract
Bacterial infections are a key precipitant of acute decompensation and acute-on-chronic liver failure in cirrhotic patients. The rising prevalence of multidrug-resistant organisms complicates intensive care unit management, making colonization screening increasingly important. In this issue, Kosuta et al report that one-third of cirrhotic intensive care unit patients were colonized with multidrug-resistant organisms, with an 82% concordance between colonizing and infecting strains. Yet colonization did not independently predict infection or short-term mortality, which were instead driven by the severity of organ dysfunction. These findings highlight host vulnerability as the main determinant of mortality, while reinforcing colonization’s role in guiding empiric therapy and regional stewardship strategies.
Core Tip: Multidrug-resistant organism colonization is frequent in critically ill cirrhotic patients and strongly predicts subsequent infection. However, colonization alone does not determine mortality, which is primarily driven by organ dysfunction severity. Colonization status remains an important tool for guiding empiric antimicrobial therapy and tailoring stewardship strategies, particularly in regions with distinct epidemiological patterns.
