{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T05:36:31Z","timestamp":1792820191094,"version":"4.5.0"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013076","name":"National Major Science and Technology Projects of China","doi-asserted-by":"publisher","award":["2025ZD01906200"],"award-info":[{"award-number":["2025ZD01906200"]}],"id":[{"id":"10.13039\/501100013076","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82570717"],"award-info":[{"award-number":["82570717"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background &amp; Aims<\/jats:title>\n                    <jats:p>Bacterial and fungal infections are major drivers of acute decompensation and acute-on-chronic liver failure (ACLF) in cirrhosis, but real-world data on the effectiveness of empiric antibiotic therapy in China are scarce. We evaluated clinical response to empiric antibiotics, identified predictors of non-response, and assessed the impact of response and secondary infection on short-term outcomes in Chinese patients with cirrhosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Approach &amp; Results<\/jats:title>\n                    <jats:p>In this multicenter retrospective cohort from 24 tertiary centers, 1,401 adults with cirrhosis and bacterial or fungal infections were included. Clinical response to first-line empiric therapy occurred in 913 patients (65%). Non-responders had higher MELD\/MELD-Na scores, more organ failures and ACLF, and more intense systemic inflammation. In multivariable models, greater ACLF grade 2\u20133, systemic inflammatory response syndrome, higher neutrophil-to-lymphocyte ratio, C-reactive protein, bilirubin, culture positivity, and lower albumin and mean arterial pressure independently predicted non-response. Non-response was independently associated with 28-day and 90-day mortality (HR 4.20 and 3.16, respectively), with consistent findings in time-dependent and center-clustered sensitivity analyses. Secondary infection developed in 7.0% of patients, was four-fold more frequent in non-responders (13.9% vs 3.3%), and nearly doubled 90-day mortality, whereas microbiological features at secondary infection did not clearly distinguish second-course responders from non-responders. Comparative analyses revealed substantial center-to-center and China-global differences in etiology, infection profile, and multidrug-resistant (MDR) burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In Chinese patients with cirrhosis, lack of early clinical response to empiric antibiotics independently predicts short-term mortality and is associated with a higher risk of clinically distinct secondary infection. Our findings support risk-adapted, locally informed empiric strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0357491","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T17:52:12Z","timestamp":1789494732000},"page":"e0357491","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical efficacy of empiric antibiotic therapy in Chinese patients with cirrhosis and bacterial infections: A multicenter study"],"prefix":"10.1371","volume":"21","author":[{"given":"Liqin","family":"Sheng","sequence":"first","affiliation":[{"name":"Haiyan People\u2019s Hospital","place":["Jiaxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiuding","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Medicine, Zhejiang University","place":["Hangzhou, Zhejiang, China"],"department":["State Key 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