High Prevalence of Antibiotic-Resistant Bacterial Infections Among Patients With Cirrhosis at a US Liver Center
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Background & aims There are limited data on the prevalence or predictors of antibiotic-resistant bacterial infections (AR-BI) in hospitalized patients with cirrhosis in North America. Exposure to systemic antibiotics is a risk factor for AR-BI; however, little is known about the effects of the increasingly used oral nonabsorbed antibiotics.Methods We analyzed data from patients with cirrhosis and bacterial infections hospitalized in a liver unit at a US hospital between July 2009 and November 2010. Multivariate logistic regression was used to determine predictors of AR-BI. Data were analyzed on the first bacterial infection of each patient (n = 115), and a sensitivity analysis was performed on all infectious episodes per patient (n = 169).Results Thirty percent of infections were nosocomial. Urinary tract infections (32%) and spontaneous bacterial peritonitis (24%) were most common. Of the 70 culture-positive infections, 33 (47%) were found to be antibiotic resistant (12 were vancomycin-resistant Enterococci, 9 were extended-spectrum β-lactamase-producing Enterobacteriaceae, 7 were quinolone-resistant gram-negative rods, and 5 were methicillin-resistant Staphylococcus aureus). Exposure to systemic antibiotics within 30 days before infection was associated independently with AR-BI, with an odds ratio (OR) of 13.5 (95% confidence interval [CI], 2.6-71.6). Exposure to only nonabsorbed antibiotics (rifaximin) was not associated with AR-BI (OR, 0.4; 95% CI, 0.04-2.8). In a sensitivity analysis, exposure to systemic antibiotics within 30 days before infection and nosocomial infection was associated with AR-BI (OR, 5.2; 95% CI, 1.5-17.7; and OR, 4.2; 95% CI, 1.4-12.5, respectively).Conclusions The prevalence of AR-BI is high in a US tertiary care transplant center. Exposure to systemic antibiotics within 30 days before infection (including those used for prophylaxis of spontaneous bacterial peritonitis), but not oral nonabsorbed antibiotics, is associated with development of an AR-BI.
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A major problem with norfloxacin is the development of antibiotic resistance.
“A major problem with the use of norfloxacin is the development of antibiotic resistance110–112, suggesting that it might be suitable for treatment lasting weeks to months but not for long-term or life-long application in patients with cirrhosis.”
From The gut microbiome and liver cancer: mechanisms and clinical translation (2017) · cites this paper as [112]
Norfloxacin may be suitable for weeks to months of treatment but not for long-term or life-long use in cirrhosis patients.
“A major problem with the use of norfloxacin is the development of antibiotic resistance110–112, suggesting that it might be suitable for treatment lasting weeks to months but not for long-term or life-long application in patients with cirrhosis.”
From The gut microbiome and liver cancer: mechanisms and clinical translation (2017) · cites this paper as [112]
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- Authors
- Tandon, P., DeLisle, A., Topal, J. E., & Garcia–Tsao, G.
- Affiliations
- University of Alberta (CA)
- Yale New Haven Hospital (US)
- Yale University (US)
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2012-11
- Volume
- 10
- Issue
- 11
- Pages
- 1291-1298
- ISSN
- 1542-3565 (ISSN-L)
- PMC
- PMC3891826
- OpenAlex
- W2112679280
- Cited by
- 158
- References
- 48
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 5 · 2023: 6 · 2022: 10 · 2021: 10 · 2020: 12 · 2019: 27 · 2018: 18 · 2017: 15 · 2016: 10 · 2015: 17 · 2014: 15 · 2013: 5
- FWCI
- 5.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (K24DK002727, P30DK034989)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Keywords
- antibiotic-resistant bacterial infections, liver cirrhosis, nosocomial infections, spontaneous bacterial peritonitis, urinary tract infection, vancomycin-resistant enterococci, extended-spectrum beta-lactamase, quinolone resistance, methicillin-resistant Staphylococcus aureus, rifaximin, antibiotic prophylaxis, risk factors
- MeSH terms
- Adult, Aged, Anti-Bacterial Agents, Bacteria, Bacterial Infections, Female, Humans, Liver Cirrhosis, Male, Middle Aged, Risk Factors, United States, Prevalence, Drug Resistance, Bacterial
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