Published online Nov 6, 2023. doi: 10.12998/wjcc.v11.i31.7530
Peer-review started: August 31, 2023
First decision: September 25, 2023
Revised: October 2, 2023
Accepted: October 17, 2023
Article in press: October 17, 2023
Published online: November 6, 2023
Processing time: 67 Days and 0.1 Hours
Regardless of etiology, complications with bacterial infection in patients with cirrhosis are reported in the range of 25%-46% according to the most recent data. Due to frequent episodes of bacterial infection and repetitive antibiotic treatment, most often with broad-spectrum gram negative coverage, patients with cirrhosis are at increased risk of encountering multidrug resistant bacteria, and this raises concern. In such patients, extended-spectrum beta-lactamase and AmpC-producing Enterobacterales, methicillin- or vancomycin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci, carbapenem-resistant Pseudomonas aeruginosa, and Acinetobacter baumannii, all of which are difficult to treat, are the most common. That is why novel approaches to the prophylaxis and treatment of bacterial infections to avoid antibiotic resistance have recently been developed. At the same time, our knowledge of resistance mechanisms is constantly updated. This review summarizes the current situation regarding the burden of antibiotic resistance, including the prevalence and mechanisms of intrinsic and acquired resistance in bacterial species that most frequently cause complications in patients with liver cirrhosis and recent developments on how to deal with multidrug resistant bacteria.
Core Tip: This review presents current data on bacterial complications in patients with cirrhosis. A comprehensive analysis of the prevalence of antibiotic resistant isolates with a brief presentation of intrinsic and acquired resistance mechanisms was performed in the most prevalent pathobionts causing infections in cirrhosis. Current approved and developing options to treat bacterial complications to avoid resistance are also discussed.