{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T08:31:32Z","timestamp":1776501092660,"version":"3.51.2"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2022,5,24]],"date-time":"2022-05-24T00:00:00Z","timestamp":1653350400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The efficacy of antibiotic prophylaxis to prevent rebleeding or infection after variceal bleeding in patients with liver cirrhosis colonized with multidrug-resistant organisms (MDROs) is unknown.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>In this retrospective study, patients with liver cirrhosis and endoscopically confirmed variceal bleeding who were treated at a tertiary care center in Germany and were screened for MDROs at the time of bleeding were eligible for inclusion. Efficacy of antibiotic prophylaxis was evaluated in patients stratified according to microbiological susceptibility testing.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>From 97 patients, the majority had decompensated liver cirrhosis (median MELD Score 17) and ACLF was present in half of the patients (47.4%). One third of patients were colonized with MDRO at baseline. De-novo infection until day 10 or the combination of de-novo infection or rebleeding were comparable among both groups (p = 0.696 and p = 0.928, log-rank-test). Risk of de-novo infection or rebleeding was not significantly increased in patients who received antibiotic prophylaxis that did not cover the MDRO found upon baseline screening. Acute-on-chronic liver failure at baseline was the strongest and only independent risk factor that was associated with both outcomes (OR 5.52, 95%-CI 1.48\u201320.61, p = 0.011 and OR 11.5, 95%-CI 2.70\u201348.62, p&lt;0.001). Neither MDRO colonization at baseline nor covering all detected MDRO with antibiotic prophylaxis (i.e. \u201cadequate\u201d prophylaxis) impacted transplant-free survival. Again, the presence of ACLF was the strongest independent risk factor associated with mortality (OR 9.85, 95%-CI 3.58\u201327.12, p&lt;0.0001).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>In this study, MDRO colonization did not increase the risk of rebleeding, infections nor death, even if antibiotic prophylaxis administered did not cover all MDRO detected at MDRO screening. Patients with ACLF had an increased risk of bleeding, infections and death.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0268638","type":"journal-article","created":{"date-parts":[[2022,5,24]],"date-time":"2022-05-24T17:36:49Z","timestamp":1653413809000},"page":"e0268638","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Impact of colonization with multidrug-resistant organisms on antibiotic prophylaxis in patients with cirrhosis and variceal bleeding"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1653-7246","authenticated-orcid":true,"given":"Victoria T.","family":"M\u00fccke","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai-Henrik-","family":"Peiffer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johanna","family":"Kessel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharina M.","family":"Schwarzkopf","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f6rg","family":"Bojunga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Zeuzem","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabian","family":"Finkelmeier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8475-8369","authenticated-orcid":true,"given":"Marcus M.","family":"M\u00fccke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,5,24]]},"reference":[{"issue":"3","key":"pone.0268638.ref001","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1053\/jhep.2003.50385","article-title":"Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators","volume":"38","author":"G D\u2019Amico","year":"2003","journal-title":"Hepatology"},{"key":"pone.0268638.ref002","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1007\/s11901-014-0241-7","article-title":"Escorsell, \u00c0. Optimizing General Management of Acute Variceal Bleeding in Cirrhosis.","volume":"13","author":"C Villanueva","year":"2014","journal-title":"Curr Hepatology Rep"},{"issue":"2","key":"pone.0268638.ref003","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.jhep.2018.03.024","article-title":"Electronic address eee, European Association for the Study of the L. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis","volume":"69","author":"European Association for the Study of the Liver","year":"2018","journal-title":"J Hepatol"},{"issue":"5","key":"pone.0268638.ref004","first-page":"611","article-title":"[Updated S2k-Guideline \"Complications of liver cirrhosis\". German Society of Gastroenterology (DGVS)].","volume":"57","author":"AL Gerbes","year":"2019","journal-title":"Z Gastroenterol"},{"issue":"6","key":"pone.0268638.ref005","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1002\/hep.510290608","article-title":"Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis","volume":"29","author":"B Bernard","year":"1999","journal-title":"Hepatology"},{"issue":"5","key":"pone.0268638.ref006","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","author":"J Fernandez","year":"2012","journal-title":"Hepatology"},{"issue":"3","key":"pone.0268638.ref007","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/j.jhep.2018.10.027","article-title":"Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with acute-on-chronic liver failure in Europe","volume":"70","author":"J Fernandez","year":"2019","journal-title":"J Hepatol"},{"key":"pone.0268638.ref008","article-title":"Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide","author":"S Piano","year":"2018","journal-title":"Gastroenterology"},{"issue":"8","key":"pone.0268638.ref009","doi-asserted-by":"crossref","first-page":"e00223","DOI":"10.14309\/ctg.0000000000000223","article-title":"Efficacy of Norfloxacin Prophylaxis to Prevent Spontaneous Bacterial Peritonitis: A Systematic Review and Meta-Analysis","volume":"11","author":"MM M\u00fccke","year":"2020","journal-title":"Clin Transl Gastroenterol"},{"key":"pone.0268638.ref010","article-title":"Rectal colonization by resistant bacteria increases the risk of infection by the colonizing strain in critically ill patients with cirrhosis","author":"V Prado","year":"2022","journal-title":"J Hepatol"},{"issue":"9","key":"pone.0268638.ref011","doi-asserted-by":"crossref","first-page":"1916","DOI":"10.1093\/cid\/ciz540","article-title":"Quinolone and Multidrug Resistance Predicts Failure of Antibiotic Prophylaxis of Spontaneous Bacterial Peritonitis","volume":"70","author":"MM M\u00fccke","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"2","key":"pone.0268638.ref012","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.jhep.2021.03.026","article-title":"Bacterial infections in patients with acute variceal bleeding in the era of antibiotic prophylaxis","volume":"75","author":"J Martinez","year":"2021","journal-title":"J Hepatol"},{"issue":"7","key":"pone.0268638.ref013","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1053\/j.gastro.2013.02.042","article-title":"Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis","volume":"144","author":"R Moreau","year":"2013","journal-title":"Gastroenterology"},{"issue":"40","key":"pone.0268638.ref014","first-page":"670","article-title":"The Role of Microbiota in Preventing Multidrug-Resistant Bacterial Infections","volume":"116","author":"Y Khodamoradi","year":"2019","journal-title":"Dtsch Arztebl Int"},{"issue":"10","key":"pone.0268638.ref015","doi-asserted-by":"crossref","first-page":"1870","DOI":"10.1136\/gutjnl-2017-314240","article-title":"Bacterial and fungal infections in acute-on-chronic liver failure: prevalence, characteristics and impact on prognosis","volume":"67","author":"J Fernandez","year":"2018","journal-title":"Gut"},{"key":"pone.0268638.ref016","article-title":"Bacterial infection-triggered acute-on-chronic liver failure is associated with increased mortality","author":"MM M\u00fccke","year":"2017","journal-title":"Liver Int"},{"issue":"4","key":"pone.0268638.ref017","doi-asserted-by":"crossref","first-page":"540","DOI":"10.3350\/cmh.2020.0034","article-title":"Acute-on-chronic liver failure as a major predictive factor for mortality in patients with variceal bleeding","volume":"26","author":"J Shin","year":"2020","journal-title":"Clin Mol Hepatol"},{"issue":"4","key":"pone.0268638.ref018","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1016\/j.jhep.2020.06.013","article-title":"The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology","volume":"73","author":"J Trebicka","year":"2020","journal-title":"J Hepatol"},{"issue":"7","key":"pone.0268638.ref019","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1086\/666331","article-title":"Association between vancomycin-resistant Enterococci bacteremia and ceftriaxone usage.","volume":"33","author":"JA McKinnell","year":"2012","journal-title":"Infect Control Hosp Epidemiol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0268638","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,24]],"date-time":"2022-05-24T17:37:13Z","timestamp":1653413833000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0268638"}},"subtitle":[],"editor":[{"given":"Pavel","family":"Strnad","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,5,24]]},"references-count":19,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0268638","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,24]]}}}