Infections in Cirrhosis

  • Sirina Ekpanyapong
  • K. Rajender ReddyEmail author
Liver (J Bajaj, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Liver


Purpose of review

Patients with cirrhosis are at high risk of developing serious infections. Bacterial infections remain the most common cause of morbidity and mortality in these patients. This review is focused on the prevalence of infections in those with cirrhosis, including multidrug-resistant (MDR) pathogens, pathogenesis of infection-related acute-on-chronic liver failure (ACLF), current treatment recommendations, and prophylactic strategies in patients with cirrhosis.

Recent findings

Recent epidemiological studies have noted an emerging prevalence of MDR bacterial infections and associated with poor prognosis, and a high rate of treatment failure and mortality. Therefore, new recommendations on empirical antibiotic use based on epidemiological data have been developed in order to improve outcomes.


Spontaneous bacterial peritonitis (SBP) and urinary tract infection (UTI) are the most frequent infections followed by pneumonia, cellulitis, and bacteremia, while pneumonia carries the highest risk of mortality. The incidence of MDR bacterial infections has been increasing, especially in healthcare-associated settings. Second infections that develop during hospitalization, multiple organ failures, and high MELD score are associated with poor survival. Preventive measures, early diagnosis, and adequate treatment of infections are essential key concepts in minimizing morbidity and mortality in patients with cirrhosis.


Cirrhosis Spontaneous bacterial peritonitis Bacterial translocation Multidrug-resistant Acute-on-chronic liver failure Vaccination 


Compliance with Ethical Standards

Conflict of Interest

Sirina Ekpanyapong, MD, declares that she has no conflict of interest.

K. Rajender Reddy, MD, declares that he has no conflict of interest for this work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologyUniversity of PennsylvaniaPhiladelphiaUSA

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