{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T14:53:43Z","timestamp":1787496823638,"version":"build-2736575974"},"reference-count":39,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2024,8,15]],"date-time":"2024-08-15T00:00:00Z","timestamp":1723680000000},"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":["Liver International"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>With the increasing rate of infections caused by multidrug\u2010resistant organisms (MDRO), selecting appropriate empiric antibiotics has become challenging. We aimed to develop and externally validate a model for predicting the risk of MDRO infections in patients with cirrhosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We included patients with cirrhosis and bacterial infections from two prospective studies: a transcontinental study was used for model development and internal validation (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091302), and a study from Argentina and Uruguay was used for external validation (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009472). All predictors were measured at the time of infection. Both culture\u2010positive and culture\u2010negative infections were included. The model was developed using logistic regression with backward stepwise predictor selection. We externally validated the optimism\u2010adjusted model using calibration and discrimination statistics and evaluated its clinical utility.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of MDRO infections was 19% and 22% in the development and external validation datasets, respectively. The model's predictors were sex, prior antibiotic use, type and site of infection, MELD\u2010Na, use of vasopressors, acute\u2010on\u2010chronic liver failure, and interaction terms. Upon external validation, the calibration slope was 77 (95% CI .48\u20131.05), and the area under the ROC curve was .68 (95% CI .61\u2013.73). The application of the model significantly changed the post\u2010test probability of having an MDRO infection, identifying patients with nosocomial infection at very low risk (8%) and patients with community\u2010acquired infections at significant risk (36%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This model achieved adequate performance and could be used to improve the selection of empiric antibiotics, aligning with other antibiotic stewardship program strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.16063","type":"journal-article","created":{"date-parts":[[2024,8,16]],"date-time":"2024-08-16T02:40:36Z","timestamp":1723776036000},"page":"2915-2928","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Development and external validation of a model to predict multidrug\u2010resistant bacterial infections in patients with cirrhosis"],"prefix":"10.1111","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7983-1450","authenticated-orcid":false,"given":"Sebasti\u00e1n","family":"Marciano","sequence":"first","affiliation":[{"name":"Liver Unit and Research Department Hospital Italiano Buenos Aires  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9356-5830","authenticated-orcid":false,"given":"Salvatore","family":"Piano","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine and Hepatology, Department of Medicine University of Padova  Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9113-5167","authenticated-orcid":false,"given":"Virendra","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Hepatology Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1439-056X","authenticated-orcid":false,"given":"Paolo","family":"Caraceni","sequence":"additional","affiliation":[{"name":"Unit of Semeiotics, Liver and Alcohol\u2010related diseases IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"},{"name":"Department of Medical and Surgical Sciences University of Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0110-5982","authenticated-orcid":false,"given":"Rakhi","family":"Maiwall","sequence":"additional","affiliation":[{"name":"Institute of Liver and Biliary Sciences  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Alessandria","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Citt\u00e0 della Salute e della Scienza Hospital University of Turin  Turin Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Liver ICU, Liver Unit, Hospital Clinic University of Barcelona  Barcelona Catalonia Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August\u2010PiSunyer  Barcelona Catalonia Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas  Barcelona Catalonia Spain"},{"name":"European Foundation of Chronic Liver Failure (EF\u2010Clif)  Barcelona Catalonia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5792-1500","authenticated-orcid":false,"given":"Dong Joon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Hallym University College of Medicine  Chuncheon Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6236-780X","authenticated-orcid":false,"given":"Sung Eun","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine Hallym Sacred Heart Hospital, College of Medicine, Hallym University  Anyang City Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6262-2997","authenticated-orcid":false,"given":"Elza","family":"Soares","sequence":"additional","affiliation":[{"name":"Gastroenterology Division, Medicine Department, Faculty of Medical Sciences University of Campinas (UNICAMP)  Campinas S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00f3nica","family":"Marino","sequence":"additional","affiliation":[{"name":"Liver Unit Hospital Dr. Carlos B. Udaondo  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julio","family":"Vorobioff","sequence":"additional","affiliation":[{"name":"Medical School Rosario University  Rosario Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9593-4620","authenticated-orcid":false,"given":"Manuela","family":"Merli","sequence":"additional","affiliation":[{"name":"Department of translation and precision medicine University of Rome Sapienza  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laure","family":"Elkrief","sequence":"additional","affiliation":[{"name":"Service de Transplantation, Service d'H\u00e9pato\u2010gastroent\u00e9rologie H\u00f4pitaux Universitaires de Gen\u00e8ve  Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Vargas","sequence":"additional","affiliation":[{"name":"Liver Unit, Department of Internal Medicine, Hospital Vall d'Hebron Universitat Aut\u00f2noma de Barcelona, CIBERehd  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksander","family":"Krag","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Odense University Hospital  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivaram","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology S.C.B. Medical College  Cuttack India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mart\u00edn","family":"Elizondo","sequence":"additional","affiliation":[{"name":"Bi\u2010Institutional Liver Transplant Unit Center (Hospital de Cl\u00ednicas\u2014Military Hospital)  Montevideo Uruguay"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria M","family":"Anders","sequence":"additional","affiliation":[{"name":"Liver Unit Hospital Aleman Buenos Aires  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melisa","family":"Dirchwolf","sequence":"additional","affiliation":[{"name":"Liver Unit Hospital Privado de Rosario  Rosario Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Mendizabal","sequence":"additional","affiliation":[{"name":"Liver Unit Hospital Universitario Austral  Pilar Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cosmas R. A.","family":"Lesmana","sequence":"additional","affiliation":[{"name":"Hepatobiliary Division, Department of Internal Medicine Dr. Cipto Mangunkusumo Hospital  Jakarta Indonesia"},{"name":"Medical Faculty Universitas Indonesia  Jakarta Indonesia"},{"name":"Digestive Disease &amp; GI Oncology Centre Medistra Hospital  Jakarta Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Toledo","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Hospital Valdivia Universidad Austral de Chile  Valdivia Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9263-8869","authenticated-orcid":false,"given":"Florence","family":"Wong","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0357-1090","authenticated-orcid":false,"given":"Francois","family":"Durand","sequence":"additional","affiliation":[{"name":"Hepatology &amp; Liver Intensive Care, Hospital Beaujon University Paris Diderot  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adri\u00e1n","family":"Gadano","sequence":"additional","affiliation":[{"name":"Liver Unit and Research Department Hospital Italiano Buenos Aires  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego H","family":"Giunta","sequence":"additional","affiliation":[{"name":"Hospital Italiano Buenos Aires University  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Angeli","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine and Hepatology, Department of Medicine University of Padova  Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the International Club of Ascites Global Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,8,15]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.12.005"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aohep.2023.101097"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41564-018-0121-y"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.13135"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.25931"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00473-0"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.4254\/wjh.v15.i3.377"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/phar.2813"},{"key":"e_1_2_12_10_1","unstructured":"Review on Antimicrobial Resistance.Tackling Drug\u2010resistant Infections Globally: Final Report and Recommendations.2016."},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-0698"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2011.03570.x"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.25532"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.10.027"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2016-312670"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m441"},{"key":"e_1_2_12_17_1","volume-title":"Analysis of Binary Data","author":"Cox DR","year":"1989"},{"key":"e_1_2_12_18_1","unstructured":"Accessed June 24 2020.http:\/\/fmwww.bc.edu\/RePEc\/bocode\/p\/pmsampsize.sthlp"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2004.06.017"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4614-1353-0"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/9780470770771"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.6782"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(01)00341-9"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1201\/9780429246593"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.11.010"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.03.024"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1717295115"},{"key":"e_1_2_12_28_1","unstructured":"Current Report.https:\/\/www.cdc.gov\/antibiotic\u2010use\/stewardship\u2010report\/current.html"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyz274"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2589-7500(22)00188-1"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-023-03048-6"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X14547233"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00009-11"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2016.292"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw425"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2019.17"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2018.166"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2018.03.029"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-019-0503-6"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31884"}],"container-title":["Liver International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.16063","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,23]],"date-time":"2024-10-23T03:08:11Z","timestamp":1729652891000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/liv.16063"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,15]]},"references-count":39,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1111\/liv.16063"],"URL":"https:\/\/doi.org\/10.1111\/liv.16063","archive":["Portico"],"relation":{},"ISSN":["1478-3223","1478-3231"],"issn-type":[{"value":"1478-3223","type":"print"},{"value":"1478-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,15]]},"assertion":[{"value":"2024-04-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}