Fig. 3.

A guide for antibiotic treatment in patients with acute-on-chronic liver failure (ACLF) according to recommendations from Fernandez et al. [81]. A Empirical treatment of patients with ACLF according to the antibiotic stewardship program, which provides the best care to patients and to reduce the risk of selecting antibiotics for multi-drug resistant bacteria. *Previous colonization, antibiotic treatment ≥5 days in the last 3 months, hospitalization ≥5 days in the last 3 months, nursing home/long-term care. **Pneumonia, secondary peritonitis (high bacterial load), high risk for severe complications (meningitis). ***≥25 mg/dl. ^#Adding one or more of these antibiotics according to the local resistance, recent antibiotic treatment (within 6 weeks), and source of infection. ^##2 or more criteria: multifocal colonization with Candida spp., antibiotic treatment or steroids, parenteral nutrition, gastroduodenal surgery or pancreatitis, renal replacement therapy. B A guide for de-escalation according to the microbiological culture results and clinical course. ESBL = Extended-spectrum beta-lactamase; MRCNS = methicillin-resistant coagulase-negative Staphylococci; MRSA = methicillin-resistant Staphylococcus aureus, VRE = vancomycin-resistant Enterococci, VSE = vancomycin-susceptible Enterococci.