Infection risk and management in patients with cirrhosis: A critical overview

Table 1 Summary of the most common bacterial infections in cirrhosis[5,6,19,71]

Infection	Community-acquired, most common bacteria	Community-acquired, first line treatment	Community-acquired, second line treatment	HCA/nosocomial, most common bacteria	HCA/nosocomial, first line treatment	HCA/nosocomial, second line treatment
Soft tissue and skin	Streptococcus pyogenes and Staphylococcus aureus	Amoxicillin/clavulanic acid third-generation cephalosporin NF: Meropenem + daptomycin + clindamycin	Piperacillin/tazobactam	MRSA, Enterococci	Meropenem ceftazidime + penicillinase, resistant penicillin	Piperacillin/tazobactam + glycopeptide daptomycin or linezolid should be considered if VRE high prevalence
Respiratory tract	Gram positives (Streptococcus pneumoniae and Staphylococcus aureus)	Quinolones amoxicillin/clavulanic acid cephalosporin + macrolide	Piperacillin/tazobactam	Gram negatives (Pseudomonas aeruginosa, Escherichia coli), ESBL, MRSA, Acinetobacter baumannii	Piperacillin/tazobactam if low MDRO risk meropenem or ceftazidime + quinolone if high MDRO risk	Consider vancomycin or linezolid if MRSA
Urinary tract	Escherichia coli and Klebsiella pneumoniae	Ciprofloxacin cotrimoxazole third-generation cephalosporin or amoxicillin/clavulanic acid (if sepsis)	Piperacillin/tazobactam	Enterobacteriae (ESBL), Enterococci (VRE), Pseudomonas aeruginosa	Fosfomycin or Nitrofurantoin for uncomplicated infections piperacillin/tazobactam or for sepsis/complicated infection	Meropenem ± glycopeptide, especially if high prevalence MDRO
SBP	Escherichia coli and Klebsiella pneumoniae	Third-generation cephalosporin amoxicillin/clavulanic acid can be considered	Quinolones oral or intravenous injection if no norfloxacin treatment	Escherichia coli (ESBL), Klebsiella pneumoniae (MDR), Enterococci (VRE), MRSA	Piperacillin/tazobactam (low MDRO prevalence) meropenem ± glycopeptide (high MDRO prevalence)	Consider linezolid or daptomycin

Fungal infections should always be considered. ESBL: Extended spectrum β-lactamase; HCA: Healthcare-associated infection; MDRO: Multidrug resistant organism; MRSA: Methicillin-resistant Staphylococcus aureus; NF: Necrotizing Fasciitis; VRE: Vancomycin-resistant Enterococci; SBP: Spontaneous bacterial peritonitis.