الفهرس 
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Abstract
Introduction : Patients with liver cirrhosis have been found to be more likely to acquire bacterial infections due to their dysregulated immune function and are highly susceptible to the development of infections caused by multidrug resistant bacteria (MDR) .They require repeated hospitalizations, are often submitted to invasive procedures and are frequently exposed to antibiotics, either as prophylaxis (long-term primary and secondary prophylaxis of spontaneous bacterial peritonitis (SBP) and short term prophylaxis in upper gastrointestinal bleeding) or as treatment. All these factors have contributed to increase the prevalence of multiple drug resistant bacteria in infections acquired in the healthcare environment, mainly in the nosocomial setting. Aim of the work: The aim of this study was to evaluate the frequency of MDR in decompensated cirrhotic patients admitted to hospital and detect possible related risk factors. Subjects and methods: The study included 178 patients with decompensated liver cirrhosis admitted at hepatology and gastroenterology unit at specialized medical hospital. The cases were subjected to full history taking (including demographic data, history of the current disease and associated chronic disease) and full clinical examination. Laboratory investigations were done including assessment of serum CRP levels. Serum CRP levels were measured using turbidimetric assay. Radiological investigations included abdominal U/S and chets X-ray. Results : Frequency of MDR was 91 %. The most common infection was SBP 22.3 % followed by 18.5 % for spontaneous bacteremia. 43.8 % of the infections were culture-positive. Klebsiella pneumonia was the most frequently isolated organism. Previous antibiotic use, previous-to-current hospital admission < 30 days, and length of current hospital stay (days) were independent predictors for the likelihood of MDR. Mechanical ventilation and central line insertion were the only 2 independent predictors for the likelihood of patients to have poor outcome. Conclusion: MDR bacterial infections were demonstrated to be associated with a very high prevalence among patients with decompensated cirrhosis due to many risks’ factors. Thus, efforts should be made to limit the spread of MDR and XDR bacteria in patients with cirrhosis. Considering the huge differences in the prevalence of MDR and XDR infections across the different geographic areas, empirical antibiotic treatment needs to be adapted to national, regional, or even local microbiological epidemiology. In addition, considering the limited available options for treating MDR and XDR bacterial infections, new antibiotics should be developed.