{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T04:20:42Z","timestamp":1792210842278,"version":"4.4.0"},"reference-count":74,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2016,6]]},"abstract":"<jats:p>Patients with cirrhosis, particularly those with decompensated cirrhosis, are at increased risk of bacterial infections that may further precipitate other liver decompensations including acute\u2010on\u2010chronic liver failure. Infections constitute the main cause of death in patients with advanced cirrhosis, and strategies to prevent them are essential. The main current strategy is the use of prophylactic antibiotics targeted at specific subpopulations at high risk of infection: prior episode of spontaneous bacterial peritonitis, upper gastrointestinal bleeding, and low\u2010protein ascites with associated poor liver function. Antibiotic prophylaxis effectively prevents not only the development of bacterial infections in all these indications but also further decompensation (variceal bleeding, hepatorenal syndrome) and improves survival. However, antibiotic prophylaxis is also associated with a clinically relevant and increasing drawback, the development of infections due to multidrug\u2010resistant organisms. Several strategies have been suggested to balance the risks and benefits of antibiotic prophylaxis. <jats:italic toggle=\"yes\">Conclusion:<\/jats:italic> Antibiotic stewardship principles such as the restriction of antibiotic prophylaxis to subpopulations at a very high risk for infection, the avoidance of antibiotic overuse, and early deescalation policies are key to achieve this balance; nonantibiotic prophylactic measures such as probiotics, prokinetics, bile acids, statins, and hematopoietic growth factors could also contribute to ameliorate the development and spread of multidrug\u2010resistant bacteria in cirrhosis. (H<jats:sc>epatology<\/jats:sc> 2016;63:2019\u20102031)<\/jats:p>","DOI":"10.1002\/hep.28330","type":"journal-article","created":{"date-parts":[[2015,11,3]],"date-time":"2015-11-03T23:39:08Z","timestamp":1446593948000},"page":"2019-2031","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":172,"title":["Antibiotic prophylaxis in cirrhosis: Good and bad"],"prefix":"10.1097","volume":"63","author":[{"given":"Javier","family":"Fern\u00e1ndez","sequence":"first","affiliation":[{"name":"Liver Unit, Hospital Clinic,University of Barcelona,Barcelona,Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August\u2010Pi\u2010Sunyer (IDIBAPS),Barcelona,Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBEREHED),Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Puneeta","family":"Tandon","sequence":"additional","affiliation":[{"name":"Cirrhosis Care Clinic, Cirrhosis Care, Liver Unit, Division of Gastroenterology,University of Alberta,Edmonton,Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Mensa","sequence":"additional","affiliation":[{"name":"Infectious Disease Department, Hospital Cl\u00ednic,University of Barcelona,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guadalupe","family":"Garcia\u2010Tsao","sequence":"additional","affiliation":[{"name":"Section of Digestive Diseases,Yale University School of Medicine,New Haven,CT"},{"name":"Section of Digestive Diseases,VA\u2010CT Healthcare System,West Haven,CT"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2016,1,11]]},"reference":[{"issue":"Suppl. 1","key":"hep28330-bib-0001-20241017","first-page":"S1","article-title":"Management of bacterial infections in cirrhosis","volume":"56","year":"2012","journal-title":"J Hepatol"},{"key":"hep28330-bib-0002-20241017","doi-asserted-by":"crossref","first-page":"2022","DOI":"10.1002\/hep.23264","article-title":"Severe sepsis in cirrhosis","volume":"50","year":"2009","journal-title":"Hepatology"},{"key":"hep28330-bib-0003-20241017","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1002\/hep.25532","article-title":"Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: a prospective study","volume":"55","year":"2012","journal-title":"Hepatology"},{"key":"hep28330-bib-0004-20241017","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1016\/j.jhep.2014.01.024","article-title":"Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013","volume":"60","year":"2014","journal-title":"J Hepatol"},{"key":"hep28330-bib-0005-20241017","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1002\/hep.20126","article-title":"Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: a randomized trial","volume":"39","year":"2004","journal-title":"Hepatology"},{"key":"hep28330-bib-0006-20241017","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1053\/j.gastro.2013.02.042","article-title":"Acute\u2010on\u2010chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis","volume":"144","year":"2013","journal-title":"Gastroenterology"},{"key":"hep28330-bib-0007-20241017","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1053\/j.gastro.2010.06.019","article-title":"Infections in patients with cirrhosis increase mortality four\u2010fold and should be used in determining prognosis","volume":"139","year":"2010","journal-title":"Gastroenterology"},{"key":"hep28330-bib-0008-20241017","first-page":"743","article-title":"Expanding consensus in portal hypertension. 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