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

Anubhav Dabas1, Mohmad Sejarali Sayeed2, Praful Kumar Chavhan3

  • 1Gastroenterology, Oxygen Hospital, Rohtak, IND.

Cureus
|June 15, 2026
PubMed

Insights

Nearly half of hospitalized patients with decompensated cirrhosis in North India develop bacterial infections, leading to significantly higher mortality. High rates of multidrug-resistant and extensively drug-resistant organisms necessitate updated treatment strategies.

Area of Science:

  • Infectious Diseases
  • Hepatology
  • Microbiology

Background:

  • Hospitalized patients with decompensated cirrhosis are at high risk for bacterial infections.
  • The Indian subcontinent is a recognized hotspot for antimicrobial resistance (AMR), yet prospective data are limited.
  • Understanding infection prevalence and resistance patterns is crucial for patient management.

Purpose of the Study:

  • To investigate the prevalence, microbiological characteristics, and outcomes of bacterial infections in hospitalized patients with decompensated cirrhosis in North India.
  • To identify predictors of infection and mortality in this patient population.
  • To assess the patterns of antimicrobial resistance, including multidrug-resistant (MDR) and extensively drug-resistant (XDR) organisms.

Main Methods:

  • A prospective observational study conducted over 18 months, enrolling 176 adult patients with decompensated cirrhosis.
  • Analysis of clinical profiles, infection prevalence, microbiological isolates, antimicrobial susceptibility, and in-hospital outcomes.
  • Multivariate logistic regression was used to identify independent predictors of infection and mortality.

Main Results:

  • Bacterial infections were documented in 46.6% of patients, associated with significantly higher in-hospital mortality (37.8% vs. 3.2%).
  • Predominant isolates included *Escherichia coli* and *Klebsiella* spp.
  • High rates of antimicrobial resistance were observed: 57.5% overall, with 45.0% MDR and 12.5% XDR organisms. Ceftriaxone susceptibility for *E. coli* was low (27.3%).

Conclusions:

  • Bacterial infections are common and associated with poor outcomes in North Indian patients with decompensated cirrhosis.
  • The high prevalence of MDR and XDR organisms makes standard empirical antibiotic therapy inadequate.
  • Urgent implementation of region-specific antibiograms, enhanced antimicrobial stewardship, and infection prevention strategies is critical.
Keywords:
antibiotic stewardshipantimicrobial resistancebacterial infectionsclinical outcomesdecompensated cirrhosisindiamultidrug-resistant organismsspontaneous bacterial peritonitis

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