Prophylaxis and Treatment of Bacterial Infections in Cirrhosis

We aim to succinctly summarize key clinical management principles in commonly encountered clinical scenarios with regard to prevention, diagnosis, and management of bacterial infections in patients with cirrhosis.

We review studies detailing the role for antibiotic prophylaxis in acute liver failure and in alcohol-related hepatitis. We also review growing concerns related to antibiotic resistance and emerging biomarkers for infection prediction in cirrhosis.

We found that there is evidence of improved outcomes with administration of antibiotic prophylaxis to cirrhotic patients in specific clinical situations (such as acute gastrointestinal hemorrhage, low ascitic total fluid protein), while evidence of benefit is lacking in other circumstances (acute liver failure, alcoholic hepatitis). Additionally, there are several biomarkers that have shown promise in predicting infection in cirrhosis, which may help us tailor antibiotic exposure and mitigate growing antibiotic resistance.