Multidrug-resistant colonization in decompensated cirrhosis outside the ICU predicts infection and poor outcomes

This study demonstrates that rectal colonization with multidrug-resistant organisms is both common and clinically significant in patients with decompensated cirrhosis outside the intensive care unit. These findings are highly relevant for hepatologists, infectious disease clinicians, and epidemiologists, as colonized ward patients faced a substantially increased risk of developing infections from their colonizing strain and experienced worse outcomes, particularly those with recent acute-on-chronic liver failure. Practically, incorporating colonization status into empirical antibiotic decision-making and evaluating targeted multidrug-resistant organism surveillance strategies beyond the intensive care unit could enhance early management and improve risk stratification. While further work is needed to assess feasibility and cost-effectiveness, our results provide a strong evidence base to inform the development of surveillance-driven approaches in routine cirrhosis care.