Knowledge Portal
Infection and sepsis in cirrhosis
Cirrhosis is associated with immune dysfunction, bacterial translocation and a high risk of infection-related decompensation. Presentation may be subtle, while nosocomial infection and multidrug-resistant organisms complicate empirical treatment. ICU care therefore depends on early cultures and source identification, prompt locally appropriate antimicrobials, careful haemodynamic support and repeated review for escalation, de-escalation and emerging fungal infection.
Key information
Guidelines and position statements
Relevant clinical practice guidelines, practice guidance, consensus statements and position papers from professional bodies and expert groups.
EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis
EASL · clinical practice guideline · 2018
Includes guidance on recognising, preventing and treating bacterial infection and spontaneous bacterial peritonitis in decompensated cirrhosis.
Open resource →Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome
AASLD · practice guidance · 2021
Authoritative recommendations on diagnostic paracentesis, SBP treatment, albumin and antimicrobial prophylaxis.
Open resource →Further context
Other useful resources
Selected review articles, practical explainers, expert discussions, reference sites and e-learning from established providers.
Infections in cirrhosis
Piano S, et al. The Lancet Gastroenterology & Hepatology. 2024;9(8):745–757.
An authoritative synthesis of epidemiology, immune dysfunction, antimicrobial resistance and management.
Open resource →Infections in decompensated cirrhosis: Pathophysiology, management, and research agenda
Toll JF, et al. Hepatology Communications. 2024;8(10):e0539.
A clinically useful open-access review with a strong focus on decompensation and future priorities.
Open resource →Infection risk and management in patients with cirrhosis: A critical overview
Suárez M, et al. World Journal of Hepatology. 2025;17(5):104468.
A recent practical review of recognition, empirical therapy, resistance and prevention.
Open resource →Antibiotics for SBP Prophylaxis – Why or Why Not?
AASLD Liver Fellow Network · clinical explainer · 2025
A thoughtful update on who may benefit from prophylaxis and the growing concern about resistance.
Open resource →Quick Tips: Spontaneous Bacterial Peritonitis
AASLD Liver Fellow Network · infographic
A compact visual primer on SBP diagnosis and treatment.
Open resource →Cirrhosis & Chronic Liver Failure
Critical Care Reviews · curated review collection
A maintained collection with dedicated sections on sepsis, fungal infection and other ICU complications.
Open resource →Acute decompensation of chronic end-stage liver disease
Deranged Physiology · ICU revision chapter · updated 2025
Includes a useful section on the practical differences encountered when sepsis complicates cirrhosis.
Open resource →