Multidrug-resistant bacterial infections in cirrhotic ICU patients in a tertiary care center: a post-pandemic study

Abstract Background Cirrhotic patients are highly susceptible to bacterial infections due to immune dysfunction, frequent hospitalizations, and invasive procedures. The rise of multidrug-resistant (MDR) organisms complicates treatment and worsens outcomes. This study aimed to evaluate the epidemiology, risk factors, and outcomes of MDR infections in cirrhotic patients admitted to the intensive care unit (ICU). Methods This prospective cohort study included cirrhotic ICU patients with suspected infection at a tertiary care center from January 2022 to December 2023. Clinical specimens were collected from the suspected site of infection, and antimicrobial susceptibility testing was performed. Intra-hospital outcomes were analyzed. Results MDR organisms were identified in 83.3% of isolates, with 78.3% among Gram-positive and 87.7% among Gram-negative bacteria. Methicillin resistance was detected in 66% of Staphylococcus species, while 39% of Enterococci were vancomycin-resistant. The most common MDR Gram-negative pathogens were ESBL-producing Enterobacterales; approximately 60% of Acinetobacter and Pseudomonas isolates were carbapenem-resistant. Advanced cirrhosis, comorbidities, invasive procedures, previous episodes of spontaneous bacterial peritonitis (SBP), and prolonged hospital stays were more common in patients with MDR infections, although none of them was statistically significant. Patients with MDR infections had higher rates of complications, including hepatic encephalopathy (35.5% vs. 21.6%, p = 206) and hepatorenal syndrome (37.3% vs. 15.7%, p = 0.063), as well as higher mortality (17.4% vs. 9.8%, p = 0.440) compared to those without. Conclusion MDR infections are frequent in cirrhotic ICU patients, with a trend toward more complications (e.g., hepatic encephalopathy and hepatorenal syndrome) and higher mortality, underscoring the need for early detection and stronger antimicrobial stewardship.