Semin Liver Dis 2022; 42(02): 173-187
DOI: 10.1055/a-1765-0056
Review Article

Management of Multidrug-Resistant Infections in Cirrhosis

Charles E. Gallaher
1   Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United Kingdom
Debbie L. Shawcross
1   Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United Kingdom
2   Institute of Liver Studies, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
› Author Affiliations


The World Health Organization describes antimicrobial resistance as one of the biggest threats to global health, food security, and development with indiscriminate use of antimicrobials globally driving the emergence of multidrug-resistant bacteria, resistant to 60% of antimicrobials in some countries. Infections with multidrug-resistant organisms (MDROs) have increased in recent decades in patients with cirrhosis, who are frequently prescribed antibiotics, regularly undergo invasive procedures such as large volume paracentesis, and have recurrent hospitalizations, posing a particular risk in this already immunocompromised cohort of patients. In this review, we explore mechanisms underlying this vulnerability to MDRO infection; the effect of bacterial infections on disease course in cirrhosis; prevalence of MDROs in patients with cirrhosis; outcomes following MDRO infection; fungal infections; antibiotics and their efficacy; and management of MDRO infections in terms of detection, antimicrobial and nonantimicrobial treatments, prophylaxis, antibiotic stewardship, the gut microbiome, and technological interventions.

Authors' Contributions

The manuscript was written by C.E.G. and revised by D.L.S. All authors approved the final submitted manuscript.

Financial Support

No funding to declare.

Publication History

Accepted Manuscript online:
07 February 2022

Article published online:
23 June 2022

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