Global Trends in Antimicrobial Resistance Among Cirrhosis Patients With Bacteremia: A Systematic Review and...

Bacteremia in cirrhosis can rapidly progress to sepsis and multiorgan failure, contributing to significant morbidity and mortality. This systematic review and meta-analysis assess global trends in antimicrobial resistance (AMR) among bacterial pathogens causing bacteremia in patients with cirrhosis.

We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO: CRD42024539347). Searches across PubMed, Embase, Web of Science, and Scopus were completed up to December 15, 2024. Pooled proportions and 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed with the I² statistic, and subgroup analyses were performed by region, bacterial species, and AMR type.

Twenty-six studies, comprising 5610 bacteremia cases, were included. The pooled bacteremia rate was 20% (95% CI, 12%-33%), with 76% (95% CI, 64%-86%) classified as nosocomial. Escherichia coli and Staphylococcus aureus accounted for 27% (95% CI, 17%-39%) and 16% (95% CI, 12%-20%) of cases, respectively. Multidrug-resistant infections were reported in 31% (95% CI, 19%-44%), with comparable rates observed in Asia (35%; 95% CI, 22%-49%) and Europe (35%; 95% CI, 26%-45%). Methicillin-resistant S. aureus was reported in 13% (95% CI, 0%-38%) of cases in Asia and 10% (95% CI, 3%-20%) in Europe. The pooled global proportion of extended-spectrum beta-lactamase-producing E. coli was 14% (95% CI, 7%-22%), with a higher estimate in Asia (21%; 95% CI, 12%-31%). Carbapenem-resistant Enterobacteriaceae were identified in 5% (95% CI, 1%-11%) of cases.

Bacteremia poses a significant global burden in cirrhosis, with geographic variability in AMR patterns. These findings highlight the urgent need for region-specific infection control, antibiotic stewardship, and enhanced AMR surveillance.