Table 1.

The MDRO scenario in ESLD awaiting liver transplantation and in liver transplant recipients

	ESLD patients, awaiting liver transplantation	Liver transplant recipients, early post-operative phase
Prevalence of MDRO infections	20–30% of culture-positive bacterial infections	5–20% of culture-positive bacterial infections
	Marked differences in prevalence and type of MDR strains among countries and centres	Marked differences in prevalence and the type of MDROs among countries and centres
Risk Factors for MDRO infections	Previous bacterial infection(s) (especially if MDRO)	Donor-derived infection caused by MDRO
	MDRO colonization	MDRO colonization before and/or after LT
	Recent and/or ongoing long-term antibiotic therapie	Recent and/or ongoing long-term antibiotic therapies
	Indwelling catheters	Indwelling catheters, prolonged mechanical ventilation
	Invasive procedures	Invasive procedures (including re-operation)
	Prophylaxis*	Microbiological samples with detailed report of mechanisms of antibiotic resistance
Tools for diagnosis of MDRO infections	Microbiological samples with detailed report of mechanisms of antibiotic resistance	Use of novel diagnostic kits able to shorten turnaround times
	Use of new diagnostic kits able to shorten turnaround times
Novel therapies for MDRO infection	New molecules to be used for empirical/targeted antibiotic therapy	New molecules to be used for empirical/targeted antibiotic therapy
Specific issues in Liver Transplant setting	Consider appropriate window and timing for LT, balancing benefit and futility of transplant	Patient and graft survival is significantly impaired in patients with MDRO infection than in patients with non-MDRO infection or without any infection
	Uncontrolled MDRO infection may be viewed, especially in ACLF patients, as a contraindication to transplantation
Preventive strategies	Hand hygiene	Hand hygiene
	Antibiotic stewardship	Antibiotic stewardship
	Update of local epidemiology (especially in ICU)	Update of local epidemiology (especially in ICU)
	Fecal microbiota transplantation**	Targeted antibiotic prophylaxis at the time of LT§
		Adoption of targeted immunosuppressive strategies in high-risk patients
		Selective digestive tract decontamination**

ESLD end-stage liver disease, ICU intensive care unit, LT liver transplantation, MDRO multidrug resistant organism. *Long-term antibiotic prophylaxis should be reserved only to patients with prior spontaneous bacterial peritonitis and variceal bleeding. **Debated indication, requiring more data. ^§in those patients with prior MDRO infection, MDR colonization