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Fever in Cirrhosis — SCE Infectious Diseases MCQ

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ModerateHealthcare-Associated InfectionsFever in CirrhosisSCE Infectious Diseases

A 50-year-old man with decompensated alcoholic cirrhosis develops a temperature of 38.8°C without an obvious source. He has no ascites (previous successful TIPS insertion). CRP is 210 mg/L. He is haemodynamically stable. Blood cultures are drawn. What is the most appropriate empirical antibiotic?

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Correct answer: C — IV Piperacillin/Tazobactam (or local HAI protocol agent) — treat as sepsis of unknown source in cirrhosis

Cirrhotic patients are functionally immunosuppressed (impaired reticuloendothelial function, complement deficiency, bacterial translocation) and have a high risk of bacterial infection with atypical presentations. Fever in cirrhosis without obvious source should be treated empirically with broad-spectrum IV antibiotics after blood/urine cultures are drawn. Piperacillin/Tazobactam is commonly used per local protocol. Without ascites, SBP is excluded. Common sources include UTI, pneumonia, cellulitis, and spontaneous bacteraemia.

Reference: EASL 2024 – Decompensated cirrhosis; BSG 2021 – Liver disease infections