{ "abstract": "Background & Aims: 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. Approach & Results: 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 2–3, 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. Conclusions: 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.", "abstract_shown": true, "affiliations": [ "Haiyan People’s Hospital, Jiaxing, Zhejiang, China", "State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China", "Hangzhou First People's Hospital Tonglu Hospital, Hangzhou, China", "Department of Infectious Diseases, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China", "Department of Infectious Diseases, Affiliated Hospital of Jiaxing University/The First Hospital of Jiaxing, Jiaxing, Zhejiang, China", "Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China", "Department of Infectious Diseases, Hangzhou Xixi Hospital, Hangzhou Sixth People's Hospital, Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China", "Department of Infectious Diseases, The First People's Hospital of Wenling, Taizhou, Zhejiang, China", "Linyi People's Hospital, Linyi, Shandong, China", "Department of Infectious Diseases, Huzhou Central Hospital, Huzhou, Zhejiang, China", "Department of Infectious Diseases, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China", "Department of Infectious Diseases, Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang, China", "Department of Infectious Diseases, Beilun District People's Hospital, Ningbo, Zhejiang, China", "The Fifth People's Hospital of Huaian, Huaian, Jiangsu, China", "Department of Infectious Diseases, Quzhou People's Hospital, Quzhou, Zhejiang, China", "Weifang People's Hospital, Weifang, Shandong, China", "Department of Infectious Diseases, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang, China", "Department of Infectious Diseases, Yiwu Central Hospital, Yiwu, Zhejiang, China", "Department of Infectious Diseases, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China", "Department of Infectious Diseases, Ningbo First Hospital, Ningbo, Zhejiang, China", "The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China", "Department of Infectious Diseases, The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China", "Dongguan Ninth People's Hospital, Dongguan Infectious Diseases Hospital, Dongguan, Guangdong, China", "Department of Gastroenterology, First Hospital of Yangtze University, Jingzhou, Hubei, China", "Gastroenterology and Hepatology, School of Medicine, Stanford University Medical Center, Palo Alto, California, United States of America", "Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China", "Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China", "Department of Infectious Diseases, Sir Run Run Shaw Alaer Hospital, School of Medicine, Zhejiang University, Alaer, Xinjiang, China" ], "article_type": "Research Article", "arxiv": null, "author_total": 41, "authors": [ { "affs": [ 0 ], "name": "Liqin Sheng" }, { "affs": [ 1 ], "name": "Xiuding Zhang" }, { "affs": [ 2 ], "name": "Haoda Weng" }, { "affs": [ 3 ], "name": "Qinzhi Deng" }, { "affs": [ 4 ], "name": "Min Deng" }, { "affs": [ 5 ], "name": "Xuwei Wu" }, { "affs": [ 6 ], "name": "Zuxiong Huang" }, { "affs": [ 7 ], "name": "Shourong Liu" }, { "affs": [ 8 ], "name": "Rui Wu" }, { "affs": [ 9 ], "name": "Chunlian Ma" }, { "affs": [ 10 ], "name": "Yao Xu" }, { "affs": [ 11 ], "name": "Jianfeng Zhong" }, { "affs": [ 12 ], "name": "Jie Yang" }, { "affs": [ 13 ], "name": "Yinxia Wu" }, { "affs": [ 14 ], "name": "Huajiang Shen" }, { "affs": [ 15 ], "name": "Feng Ding" }, { "affs": [ 16 ], "name": "Fang Wang" }, { "affs": [ 17 ], "name": "Xuezhen Zhai" }, { "affs": [ 18 ], "name": "Chunxian Peng" }, { "affs": [ 19 ], "name": "Haotang Ren" }, { "affs": [ 20 ], "name": "Jie Jin" }, { "affs": [ 21 ], "name": "Xiangfei Xu" }, { "affs": [ 22 ], "name": "Xiaofei Li" }, { "affs": [ 23 ], "name": "Xiaoting Ye" }, { "affs": [ 24 ], "name": "Guoqing Qian" }, { "affs": [ 25 ], "name": "Shuilin Sun" }, { "affs": [ 26 ], "name": "Xuebing Yao" }, { "affs": [ 27 ], "name": "Haifeng Miao" }, { "name": "Qianggu Xiao" }, { "name": "Shaoheng Ye" }, { "name": "Qing Zhang" }, { "name": "Xinyi Xu" }, { "name": "Xianbin Xu" }, { "name": "Yue Yu" }, { "name": "Huilan Tu" }, { "name": "Xinrong Zhang" }, { "name": "Rui Huang" }, { "name": "Qiao Yang" }, { "name": "Jifang Sheng" }, { "name": "Yu Shi" }, { "name": "Xia Yu" } ], "bibtex": "https://research.draconitic.com/paper/esggcp32yb7am.bib", "cited_by": 1, "doi": "10.1371/journal.pone.0357491", "fulltext_url": null, "id": "esggcp32yb7am", "issns": [ "1932-6203" ], "landing_url": "https://doi.org/10.1371/journal.pone.0357491", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2721|Liver Disease and Transplantation" ], [ "plos", "/Biology and life sciences/Biochemistry/Proteins/C-reactive proteins" ], [ "plos", "/Biology and life sciences/Microbiology/Microbial control/Antimicrobials/Antibiotics" ], [ "plos", "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Sepsis/Systemic inflammatory response syndrome" ], [ "plos", "/Medicine and health sciences/Epidemiology/Medical risk factors" ], [ "plos", "/Medicine and health sciences/Gastroenterology and hepatology/Liver diseases/Cirrhosis" ], [ "plos", "/Medicine and health sciences/Medical conditions/Infectious diseases/Fungal diseases" ], [ "plos", "/Medicine and health sciences/Medical conditions/Infectious diseases/Nosocomial infections" ], [ "plos", "/Medicine and health sciences/Pharmacology/Drugs/Antimicrobials/Antibiotics" ], [ "plos", "/People and places/Population groupings/Ethnicities/Asian people/Chinese people" ] ], "openalex": "W7213358795", "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0357491&type=printable", "pmcid": null, "pmid": null, "published": "2026-09-15", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/esggcp32yb7am.ris", "sources": [ { "first_seen": "2026-10-30T12:17:49Z", "native_id": "10.1371/journal.pone.0357491", "source": "plos", "url": "https://doi.org/10.1371/journal.pone.0357491" } ], "subjects": [ { "field": "biology", "origin": "plos:microbiology", "subfield": "microbiology" }, { "field": "medicine", "origin": "plos:epidemiology", "subfield": "epidemiology-public-health" }, { "field": "medicine", "origin": "plos:infectious diseases", "subfield": "infectious-disease" } ], "title": "Clinical efficacy of empiric antibiotic therapy in Chinese patients with cirrhosis and bacterial infections: A multicenter study", "title_text": "Clinical efficacy of empiric antibiotic therapy in Chinese patients with cirrhosis and bacterial infections: A multicenter study", "type": "peer-reviewed", "updated_at": "2026-10-30T12:17:49Z", "url": "https://research.draconitic.com/paper/esggcp32yb7am", "venue": "PLOS One", "versions": [] }