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Review
. 2020 Jan;14(1):24-34.
doi: 10.1007/s12072-019-10004-1. Epub 2019 Dec 3.

Antimicrobial resistance in chronic liver disease

Vishal C Patel  1   2   3 , Roger Williams  4   5
Affiliations
Review

Antimicrobial resistance in chronic liver disease

Vishal C Patel et al. Hepatol Int. 2020 Jan.

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 break-through 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.

Keywords: Antibiotic resistance; Antibiotic stewardship; Chronic liver disease; Cirrhosis; Faecal microbial transplantation; Immune modulation; Multi-drug resistant organism; Rapid diagnostic tests; Resistome.

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Conflict of interest statement

Vishal C. Patel has received speakers fees and an educational bursary from Norgine Ltd. Roger Williams declares he has no conflict of interest.

Figures

Fig. 1
Fig. 1
Strategies for effective antibiotic use and combating AMR in cirrhosis
See this image and copyright information in PMC

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