Antibiotic exposure linked to new multidrug-resistant organisms in advanced cirrhosis

A prospective cohort study at University Hospital Frankfurt examined cumulative antibiotic exposure and acquisition of multidrug-resistant organisms (MDROs) in 256 consecutive adults with advanced chronic liver disease enrolled during 2020–2023. Investigators quantified exposure using defined daily doses (DDD) and antibiotic use density, with systematic microbiological surveillance for MDRO colonization and infection. Mortality analyses treated liver transplantation as a competing event.

Among 246 patients without MDROs on their first admission swab, new acquisition of vancomycin-resistant enterococci (VRE) or multidrug-resistant Gram-negative bacteria was strongly associated with cumulative antibiotic exposure (p<0.001). The estimated 20% probability threshold for VRE acquisition occurred at 9.6 cumulative DDDs of any antibiotic. Lower thresholds were reported for β-lactam/β-lactamase inhibitor combinations, carbapenems, and glycopeptides, although class-specific values were not provided in the abstract.

New MDRO detection during follow-up was independently associated with increased 180-day mortality (HR 2.15, 95% CI 1.27–3.64; p=0.004); baseline detection was not. These findings support attention to cumulative antibiotic burden in antimicrobial stewardship for advanced cirrhosis. However, this single-center observational study cannot establish causality or validate an antibiotic stopping threshold. The full text was unavailable, limiting assessment of adjustment variables and other methodological details.