Clinical efficacy of empiric antibiotic therapy in Chinese patients with cirrhosis and bacterial infections: A multicenter study

@article{sheng2026clinical,
  title = {{Clinical efficacy of empiric antibiotic therapy in Chinese patients with cirrhosis and bacterial infections: A multicenter study}},
  author = {Liqin Sheng and Xiuding Zhang and Haoda Weng and Qinzhi Deng and Min Deng and Xuwei Wu and Zuxiong Huang and Shourong Liu and Rui Wu and Chunlian Ma and Yao Xu and Jianfeng Zhong and Jie Yang and Yinxia Wu and Huajiang Shen and Feng Ding and Fang Wang and Xuezhen Zhai and Chunxian Peng and Haotang Ren and Jie Jin and Xiangfei Xu and Xiaofei Li and Xiaoting Ye and Guoqing Qian and Shuilin Sun and Xuebing Yao and Haifeng Miao and Qianggu Xiao and Shaoheng Ye and Qing Zhang and Xinyi Xu and Xianbin Xu and Yue Yu and Huilan Tu and Xinrong Zhang and Rui Huang and Qiao Yang and Jifang Sheng and Yu Shi and Xia Yu},
  journal = {PLOS One},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pone.0357491},
  url = {https://doi.org/10.1371/journal.pone.0357491},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Clinical efficacy of empiric antibiotic therapy in Chinese patients with cirrhosis and bacterial infections: A multicenter study
AU  - Liqin Sheng
AU  - Xiuding Zhang
AU  - Haoda Weng
AU  - Qinzhi Deng
AU  - Min Deng
AU  - Xuwei Wu
AU  - Zuxiong Huang
AU  - Shourong Liu
AU  - Rui Wu
AU  - Chunlian Ma
AU  - Yao Xu
AU  - Jianfeng Zhong
AU  - Jie Yang
AU  - Yinxia Wu
AU  - Huajiang Shen
AU  - Feng Ding
AU  - Fang Wang
AU  - Xuezhen Zhai
AU  - Chunxian Peng
AU  - Haotang Ren
AU  - Jie Jin
AU  - Xiangfei Xu
AU  - Xiaofei Li
AU  - Xiaoting Ye
AU  - Guoqing Qian
AU  - Shuilin Sun
AU  - Xuebing Yao
AU  - Haifeng Miao
AU  - Qianggu Xiao
AU  - Shaoheng Ye
AU  - Qing Zhang
AU  - Xinyi Xu
AU  - Xianbin Xu
AU  - Yue Yu
AU  - Huilan Tu
AU  - Xinrong Zhang
AU  - Rui Huang
AU  - Qiao Yang
AU  - Jifang Sheng
AU  - Yu Shi
AU  - Xia Yu
PY  - 2026
DA  - 2026/09/15
JO  - PLOS One
DO  - 10.1371/journal.pone.0357491
UR  - https://doi.org/10.1371/journal.pone.0357491
AB  - 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.
SN  - 1932-6203
ER  -