Editorial
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2023; 11(35): 8242-8246
Published online Dec 16, 2023. doi: 10.12998/wjcc.v11.i35.8242
Antibiotic treatment in cirrhotic patients
Marco Fiore, Sebastiano Leone
Marco Fiore, Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
Sebastiano Leone, Division of Infectious Diseases, San Giuseppe Moscati” Hospital, Avellino 83100, Italy
Author contributions: Fiore M and Leone S contributed to the manuscript equally.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
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: Marco Fiore, MD, Academic Fellow, Doctor, Professor, Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Piazza Miraglia 2, Naples 80138, Italy. marco.fiore@hotmail.it
Received: November 3, 2023
Peer-review started: November 3, 2023
First decision: November 22, 2023
Revised: November 23, 2023
Accepted: December 5, 2023
Article in press: December 5, 2023
Published online: December 16, 2023
Processing time: 40 Days and 8.4 Hours
Abstract

In this editorial, we comment on the article by Liakina V: “Antibiotic resistance in patients with liver cirrhosis: Prevalence and current approach to tackle” (World J Clin Cases 2023, 11: 7530-7542). In this excellent review, Liakina presents current data on bacterial complications in patients with cirrhosis. Bacterial infections are the most common complication in patients with liver cirrhosis. We focus specifically on spontaneous bacterial peritonitis (SBP) which is the most representative infectious complication. Liakina V suggested starting empirically, in all patients with suspected SBP, third-generation cephalosporins when the number of polymorphonuclear leukocytes (PMNs) in ascites is greater than 250/mm3. This statement creates some doubts in our clinical practice so we discuss on the unsolved pitfalls of diagnosis and treatment that are often encountered in patients with ascitic fluid infections, especially on bacterascites that is defined as ascitic bacterial growth with PMNs below 250/mm3. The severity of liver disease and overall prognosis are highly comparable for patients with bacterascites and SBP in some recent well-conducted studies. Furthermore, we present a brief analysis of the prevalence of antibiotic-resistant isolates with an introduction of currently approved antibiotic drug options to treat ascitic fluid infections avoiding antibiotic resistance. In light of the most recent epidemiological data, third-generation cephalosporins should not be considered as an empirical antibiotic treatment of choice for ascitic fluid infections.

Keywords: Spontaneous bacterial peritonitis; Bacterascites; Multidrug resistance; Cirrhosis; End-stage liver disease

Core Tip: In this editorial, we comment on the article by Liakina: “Antibiotic resistance in patients with liver cirrhosis: Prevalence and current approach to tackle” (World J Clin Cases 2023, 11: 7530-7542). Our focus is on the unresolved pitfalls in diagnosing and treating cirrhotic patients with an examination of the frequency of antibiotic-resistant isolates, a brief outline of resistance mechanisms in the most common causative agents, and a list of antibiotic drug options that are currently approved.