Burden, risk factors, and outcomes of multi-drug resistant bacterial colonization at multiple sites in patients with cirrhosis

•Multi-drug resistant organism (MDRO) colonization at multiple sites admission and day-7 was assessed in patients with cirrhosis•80% of were colonized MDROs (20% pan-drug bacteria).•Rectum the commonest site colonization, followed by nose, skin central line•Multiple precipitants acute decompensation, norfloxacin prophylaxis, infection drug bacteria independently predisposed to MDROs.•MDRO colonization; especially increased risk infections bacteria, multi-organ failures, mortality cirrhosis•Local epidemiology surveillance cultures can guide antimicrobial stewardship decisions cirrhosis patients. BackgroundBurden multi-drug is reported highest from India. We evaluated whether barriers predisposes such poor outcomes cirrhosis.MethodsWe prospectively performed swab cultures, susceptibility (AST), genotype testing for rectum, composite-skin, central-line (2020-2021) on follow-up a tertiary institute. analyzed clinical data, factors MDROs, patients.ResultsOf 125 aged 49 years, 85.6% males, 60.8% ACLF, 99 (79.2%) identified as colonizers. MDRO-colonization skin, line observed 72.7% (88/121), 30.0% (36/120), 14.9% (18/121), 3.3% (4/121) patients, respectively. Patients ESBL (71/125), CRE (67/125), MDR-Enterococcus (48/125), MDR-Acinetobacter (21/125), or MRSA (4/125).Multiple acute-decompensation (OR:3.4, p=0.042), prophylaxis (OR:3.9, p=0.008), MDRO (OR:8.9, p=0.041) independent predictors colonization.Colonization (OR: 8.5, p=0.017) 7.5, p<0.001). While any-site colonizers greater cerebral failure poorer Child-Pugh scores, nasal higher circulatory failures than non-colonizers (p<0.05).Patients >1site (prevalence:30%) developed (p<0.05), (OR:7.9, p<0.001), 30-day survival (HR:2.0, p=0.005).ConclusionsA strikingly high burden among Indian cirrhotics necessitates urgent control measures. Multiple increases MDR-infections, cirrhosis. Burden Of (4/125). colonization. Colonization (p<0.05). p=0.005). A