Acute-on-Chronic Liver Failure

Bechstein: Patients have developed ACLF either because of community-acquired or nosocomial infection including so-called spontaneous bacterial peritonitis (SBP) or because of gastrointestinal bleeding or encephalopathy. In the former case, the focus of infection should be identified and organisms isolated with immediate subsequent empiric calculated antibiotic therapy. In patients with ACLF following gastrointestinal bleeding or encephalopathy, the high risk of subsequent sepsis justifies prophylactic antibiotics. The choice of antibiotics depends upon previous isolates from the patient and the spectrum of organisms and antibiotic resistances typically encountered in the specific local setting (intensive care unit (ICU), hospital) - in other words: consult with local microbiology and infectious disease colleagues to draw up local standard operating procedures for these cases