The problem of antimicrobial resistance in chronic liver disease

AMR is a serious problem for patients with decompensated cirrhosis. Bacterial infections are common in patients with cirrhosis, and are associated with the need for hospitalisation, the development of complications, and mortality. The need for repeated courses or long-term use of antibiotics, together with repeated hospitalisations and invasive procedures, places patients with cirrhosis at high risk of antimicrobial resistant infections. Indeed, a third of infections in patients with cirrhosis are estimated to be due to multidrug-resistant bacteria, although there are large differences in prevalence between countries. The problem will only grow with time—data from the Global Burden of Disease Study indicate that there was a significant increase in age-standardised prevalence of decompensated cirrhosis between 1990 and 2017.