Bacterial infections are a frequent complication in cirrhotic patients and are associated with worse outcomes.1 In addition, population-based studies have shown that cirrhosis is a predisposing factor for the development of nosocomial infections.1, 2 Although only 25–35% of the infections among patients with cirrhosis occur during their hospital stay, this incidence is five times higher than in patients admitted without cirrhosis.1 Bacterial infection increases the mortality rate in decompensated patients with cirrhosis up to four times, reaching 30% at one month and 63% at one year.2

In recent years, the growing use of invasive diagnostic and therapeutic procedures, the widespread implementation of antibiotic prophylaxis and the increasing use of broad-spectrum antibiotics have led to a change in the epidemiology of infections in cirrhotic patients. In fact, an increase in the number of infections caused by multidrug resistant microorganisms (MDRM) and fungi1, 2, 3, 4, 5, 6, 7, 8 has been reported. It has also been observed that MDRM infections are associated with higher infection-related mortality in patients with cirrhosis.9 This change in the epidemiology of infections has prompted a shift in the initial empirical antibiotic approach when infections are diagnosed in these patients. Moreover, it has been recommended to take into account several factors (time of acquisition of the infection, severity of infections, individual risk factors for MDRM infections, source and, particularly, the local epidemiology of infections) in this decision-making process.9, 10, 11, 12 Particularly, updated knowledge of the local epidemiology of infections has become a key factor for antibiotic treatment selection in these patients.

We aim to characterize bacterial infections in patients with cirrhosis admitted to our center and to identify the associated risk factors for MDRM infections in this population.