Bacterial Infections in Decompensated Cirrhosis: Clinical Profile, Microbiology, and Antimicrobial Resistance...

Background Hospitalised patients with decompensated cirrhosis face a high risk of bacterial infections. Antimicrobial resistance (AMR) is increasing globally, yet prospective data from the Indian subcontinent - a recognised AMR hotspot - remain limited. Methods This prospective observational study enrolled 176 consecutively hospitalised adults with decompensated cirrhosis over 18 months (September 2022 to February 2024). We analysed clinical profiles, infection prevalence, microbiological isolates, antimicrobial susceptibility patterns, and in-hospital outcomes. Multivariate logistic regression identified independent predictors of infection and mortality. Results Bacterial infections were documented in 82 patients (46.6%). Infected patients were younger (mean age, 48.5 vs. 53.8 years) and predominantly male (76.8%), with higher disease severity (93.9% Child-Turcotte-Pugh (CTP) class C; 79.3% Model for End-Stage Liver Disease-sodium (MELD-Na) >21). In-hospital mortality was significantly higher in infected patients (31/82, 37.8%) compared with non-infected patients (3/94, 3.2%; p < 0.001). Culture positivity was 48.8% (40/82), with Escherichia coli (27.5%) and Klebsiella spp. (17.5%) predominating. Overall, drug resistance was 57.5%, comprising 45.0% multidrug-resistant (MDR) and 12.5% extensively drug-resistant (XDR) organisms. MDR prevalence was highest in urinary tract infections (UTIs) (72.7%), while XDR was most frequent in spontaneous bacterial peritonitis (SBP) (33.3%). Susceptibility of E. coli to ceftriaxone was only 27.3%. Elevated international normalised ratio (INR) and hypoalbuminemia independently predicted infection, whereas hyperbilirubinemia predicted mortality. Conclusion Bacterial infections affect nearly half of hospitalised patients with decompensated cirrhosis in North India and are associated with markedly poor outcomes. The alarmingly high prevalence of MDR and XDR organisms renders conventional empirical antibiotics inadequate. Region-specific antibiograms, enhanced antimicrobial stewardship, and infection prevention strategies are urgently needed in this vulnerable population.