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Antibiotic resistance in patients with liver cirrhosis: Prevalence and current approach to tackle
1Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania.
Abstract:
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.
Insights
Patients with cirrhosis face high rates of bacterial infections and antibiotic resistance. This review details common resistant bacteria, their mechanisms, and new strategies for managing infections in liver cirrhosis patients.
Area of Science:
- Hepatology
- Infectious Diseases
- Microbiology
Background:
- Bacterial infections are common in cirrhosis patients, affecting 25-46%.
- Frequent antibiotic use increases the risk of multidrug-resistant (MDR) bacteria in this population.
- Common MDR pathogens include ESBL/AmpC-producing Enterobacterales, MRSA, VRE, carbapenem-resistant Pseudomonas aeruginosa, and Acinetobacter baumannii.
Purpose of the Study:
- To review the current landscape of antibiotic resistance in bacterial infections complicating liver cirrhosis.
- To elucidate the prevalence and mechanisms of both intrinsic and acquired resistance in key bacterial species.
- To highlight recent advancements in managing MDR bacterial infections in patients with cirrhosis.
Main Methods:
- Literature review of recent data on bacterial infections and antibiotic resistance in cirrhosis.
- Analysis of prevalence and resistance mechanisms of common bacterial pathogens.
- Summary of novel prophylactic and therapeutic approaches against MDR bacteria.
Main Results:
- Cirrhosis patients exhibit a high burden of bacterial infections, frequently caused by MDR organisms.
- Specific MDR bacteria like carbapenem-resistant Pseudomonas aeruginosa and vancomycin-resistant Enterococci pose significant treatment challenges.
- Understanding resistance mechanisms is crucial for developing effective treatment strategies.
Conclusions:
- There is an urgent need for novel strategies to prevent and treat bacterial infections in cirrhosis patients to combat rising antibiotic resistance.
- Continued research into resistance mechanisms is vital for guiding the development of new therapies.
- Effective management of MDR bacteria is essential for improving outcomes in patients with liver cirrhosis.
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