{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T02:16:37Z","timestamp":1780107397153,"version":"3.54.0"},"reference-count":18,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,11,20]],"date-time":"2024-11-20T00:00:00Z","timestamp":1732060800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Bowel colonization with antimicrobial\u2010resistant bacteria has been associated with worse clinical outcomes in patients with cirrhosis; however, it has not been studied in patients with acute\u2010on\u2010chronic liver failure (ACLF). We evaluated whether fecal isolation of carbapenem\u2010resistant gram\u2010negative bacteria (CR\u2010GNB) among patients with ACLF affects short\u2010term outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients of APASL\u2010ACLF (<jats:italic>n<\/jats:italic>\u2009=\u2009339) were screened between June 2020 and December 2021, and 150 were included. Stool cultures were carried out at baseline and every 5\u2009days thereafter until discharge or death. All surviving patients were followed until 60\u2009days after discharge.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean age was 44.8 (8.8) years, with 86% males and alcohol as etiology in 66%. CR\u2010GNB organisms were isolated from stool in 42% of hospitalized ACLF patients, with <jats:styled-content style=\"fixed-case\"><jats:italic>E.\u2009coli<\/jats:italic><\/jats:styled-content> and <jats:italic>Klebsiella<\/jats:italic> pneumoniae as the most common species. Patients with CR\u2010GNB fecal carriage were associated with higher CTP, MELD, and DF scores but not with recent antibiotics, proton pump inhibitors, or lactulose use. Extraintestinal infections developed in 59.3% overall, most commonly UTI, pneumonia, and SBP. Infectious complications developed in 57.3% and 19.7% with and without CR\u2010GNB in the stool (RR: 5.5; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Peripheral cultures were positive in 60.7% with infections, with species concordant with the fecal isolates found in 90.7%. Isolation of CR\u2010GNB from stool and high bilirubin were independently associated with both in\u2010hospital mortality and 60\u2010day mortality (<jats:italic>p<\/jats:italic>\u2009=\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Hospitalized ACLF patients with CR\u2010GNB in the stool have a significantly higher risk of extraintestinal infections, in\u2010hospital mortality, and short\u2010term mortality up to 60\u2009days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Number<\/jats:title><jats:p>[NCT04383106].<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.16830","type":"journal-article","created":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T04:33:38Z","timestamp":1732163618000},"page":"528-536","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Bowel Colonization With Carbapenem\u2010Resistant Bacteria Is Associated With Short\u2010Term Outcomes in Patients With Acute\u2010On\u2010Chronic Liver Failure"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1885-6996","authenticated-orcid":false,"given":"Satender\u00a0Pal","family":"Singh","sequence":"first","affiliation":[{"name":"Department of Hepatology Institute of Liver and Biliary Sciences (ILBS)  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikram","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Department of Hepatology Institute of Liver and Biliary Sciences (ILBS)  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pratibha","family":"Kale","sequence":"additional","affiliation":[{"name":"Department of Microbiology Institute of Liver and Biliary Sciences (ILBS)  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guresh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Statistics Institute of Liver and Biliary Sciences (ILBS)  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikas","family":"Khillan","sequence":"additional","affiliation":[{"name":"Department of Microbiology Institute of Liver and Biliary Sciences (ILBS)  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajan","family":"Vijayaraghavan","sequence":"additional","affiliation":[{"name":"Department of Hepatology Institute of Liver and Biliary Sciences (ILBS)  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,11,20]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.25532"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.12.005"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0168\u20108278(12)60002\u20106"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102017\u2010314240"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2015.12.005"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1806.110139"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix270"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-020-00816-4"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/tid.12169"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.12.042"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2022.03.001"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2023.100788"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072\u2010019\u201009946\u20103"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2014.06.012"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.4066\/AMJ.2014.1926"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijmm.IJMM_17_144"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10096\u2010017\u20103110\u20109"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000003231"}],"container-title":["Journal 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