Researchers at EF CLIF, Hospital Clínic de Barcelona and Goethe University Frankfurt conducted this study on a total of 907 patients, of which 550 were cirrhotic, admitted to the intensive care units at the Hospital Clínic de Barcelona, Spain, and University Clinic Frankfurt, Germany. Rectal colonization by antibiotic-resistant strains was common in both cohorts (42.6% in Barcelona and 47% in Frankfurt). Extended-spectrum beta-lactamase- Enterobacterales were the most predominant multidrug-resistant bacteria isolated in rectal swabs in the group of 129 patients from Spain, whereas vancomycin-resistant enterococci were found to be the predominant colonizing strain in the 421 patients in Germany. Multidrug-resistant bacteria carriers showed higher risk of developing severe bacterial infections at short-term. “This is, by far, the largest epidemiological surveillance investigation ever performed in cirrhosis”, said Javier Fernandez, clinical researcher at EF Clif and Head of the Liver Intensive Care Unit at Hospital Clínic de Barcelona, Spain. “We believe that epidemiological surveillance (periodic rectal swabs) constitutes a key measure for early identification of antibiotic-resistant bacteria carriers and helps to delineate empirical antibiotic strategies and de-escalation policies in decompensated cirrhosis”.

This study was supported by the Institute of Health Carlos III (ISCIII), PI16/00885.

Other authors on the study are Verónica Prado (MD), María Hernández-Tejero (MD), Marcus Mücke, Francesc Marco (MD, PhD), Wenyi Gu (MD), Alex Amoros, David Toapanta (MD), Enric Reverter (MD, PhD), Carlos de la Peña-Ramirez, Laura Altenpeter (MD), Octavi Bassegoda (MD), Gabriel Mezzano (MD), Fátima Aziz, Adria Juanola (MD), Sergio Rodriguez-Tajes (MD, PhD), Vanessa Chamorro, David López, Marta Reyes, Michael Hogardt, Volkhard A.J. Kempf, Philip Ferstl, Stefan Zeuzem, José Antonio Martínez (MD, PhD), Jordi Vila (MD, PhD), Vicente Arroyo (MD, PhD), and Jonel Trebicka (MD, PHD).

Publication information

Prado, V., Hernández-Tejero, M., Mücke, M. M., Marco, F., Gu, W., Amoros, A., Toapanta, D., Reverter, E., de la Peña-Ramirez, C., Altenpeter, L., Bassegoda, O., Mezzano, G., Aziz, F., Juanola, A., Rodríguez-Tajes, S., Chamorro, V., López, D., Reyes, M., Hogardt, M., Kempf, V. A. J., Ferstl, P. G., Zeuzem, S., Martínez, J. A., Vila, J., Arroyo, V., Trebicka, J., Fernandez, J. Rectal colonization by resistant bacteria increases the risk of infection by the colonizing strain in critically ill patients with cirrhosis. J. Hepatol. 2022. DOI: 10.1016/j.jhep.2021.12.042