We read with interest the recent letter to the editor from Waidmann et al1 investigating the effect of multidrug resistant (MDR) bacteria intestinal colonisation on the prognosis of patients with cirrhosis. The authors concluded that infections due to MDR bacteria and asymptomatic intestinal colonisation with MDR bacteria are a risk factor for mortality in cirrhosis. That information expands the relevance of preventing and treating infections due to MDR bacteria in patients with cirrhosis.

Infections due to MDR bacteria are mostly nosocomial in origin and represent an increasing threat in decompensated cirrhosis, due to the high requirement of changing antibiotics and its associated mortality.2 According to the actual pathogenic hypothesis of spontaneous infections in cirrhosis, a nosocomial spontaneous infection due to MDR bacteria should be preceded by its colonisation of the intestinal lumen and …