Multidrug-resistant organism colonization in critically ill cirrhotic patients: Marker or mediator of mortality?

Bacterial infections are a key precipitant of acute decompensation and acute-on-chronic liver failure in cirrhotic patients. The rising prevalence of multidrug-resistant organisms complicates intensive care unit management, making colonization screening increasingly important. In this issue, Kosuta et al report that one-third of cirrhotic intensive care unit patients were colonized with multidrug-resistant organisms, with an 82% concordance between colonizing and infecting strains. Yet colonization did not independently predict infection or short-term mortality, which were instead driven by the severity of organ dysfunction. These findings highlight host vulnerability as the main determinant of mortality, while reinforcing colonization's role in guiding empiric therapy and regional stewardship strategies.