Antimicrobial resistance in chronic liver disease

Abstract

High levels of antimicrobial drug resistance deleteriously affecting the outcome of treatment with antibacterial agents are causing increasing concern worldwide. This is particularly worrying in patients with cirrhosis with a depressed immune system and heightened susceptibility to infection. Antibiotics have to be started early before results of microbiological culture are available. Current guidelines for the empirical choice of antibiotics in this situation are not very helpful, and embracing antimicrobial stewardship including rapid de-escalation of therapy are not sufficiently emphasised. Multi-drug resistant organism rates to quinolone drugs of up to 40% are recorded in patients with spontaneous bacterial peritonitis on prophylactic antibiotics, leading to a breakthrough recurrence of intra-peritoneal infection. Also considered in this review is the value of rifaximin-α, non-selective beta-blockers, and concerns around proton pump inhibitor drug use. Fecal microbial transplantation and other gut-targeting therapies in lessening gut bacterial translocation are a promising approach, and new molecular techniques for determining bacterial sensitivity will allow more specific targeted therapy.

Risk Factors of Multidrug-Resistant Bacteria in Lower Respiratory Tract Infections: A Systematic Review and Meta-Analysis

“…Patients with comorbidities, such as chronic respiratory disease (COPD, asthma, and bronchiectasis), chronic liver disease, and cerebral disease are associated with the development of MDR bacteria, as they are particularly susceptible to bacterial infections and usually require repeated hospitalizations, antibiotic treatment, and invasive procedures [ 42 , 54 ]. The same is true for more severe patients who have higher disease severity scores.…”

The Role of the Microbiome in Liver Cancer

“…These could be circumvented using ‘safe’ antibiotics like norfloxacin. Nonetheless, long-term treatments with antibiotics can lead to antimicrobial resistance (AMR) [ 115 , 116 ]; multidrug-resistant infections, particularly in decompensated cirrhotic patients, are a key consideration [ 117 , 118 ].…”

Modulating the gut–liver axis and the pivotal role of the faecal microbiome in cirrhosis

“…32 AMR is focusing efforts on investigating and developing effective alternative non-antibiotic based therapies for bowel decontamination designed to curtail PAMPs and bacterial translocation in cirrhosis. 33 Rifaximin is a non-absorbable antibiotic licensed for the treatment of recurrent HE. Rifaximin's efficacy may be attributed to its impact on modulating the metabolic function of the gut microbiota rather than a change in relative bacterial abundance, although this is undergoing further evaluation in studies.…”