Patient selection: hospitalized patients with cirrhosis
A cirrhotic may develop infections with:
(1) Pseudomonas aeruginosa
(2) methicillin-resistant Staphylococcus aureus (MRSA)
(3) extended-spectrum beta-lactamase producing Enterobacteriaceae
(4) Enterococcus faecium
A cirrhotic patient with a multi-drug resistant bacteria was more likely to have septic shock and/or to die.
Risk factors for multi-drug resistant bacteria:
(1) nosocomial origin for the infection (developed after the first 48 hours in the hospital)
(2) long-term prophylaxis with norfloxacin
(3) recent therapy with a beta-lactam antibiotic
(4) recent infection with a multi-drug resistant bacteria
Common empiric antibiotic regimens are often ineffective in treating a cirrhotic patient with a multi-drug resistant bacteria.
