Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with acute-on-chronic liver failure in Europe.

•MDR bacterial infections are a prevalent, growing and complex healthcare problem in decompensated cirrhosis and ACLF.•Prevalence increased from 29% to 38% in culture-positive infections from 2011 to 2017-2018.•Antibiotic resistance negatively impacts prognosis and is associated with higher mortality rates.•Nosocomial infection, ICU admission and recent hospitalization are independent risk factors of MDR infection.•Strategies aimed at preventing the spread of antibiotic resistance in cirrhosis should be urgently evaluated.