Authors’ reply

We appreciate the comments of Dr. Basyigit on our recent study showing that antibiotic prophylaxis in cirrhotic patients can reduce recurrence of cellulitis mainly caused by gram-negative bacteria. Dr. Basyigit’s concern on the increased gram-negative cellulitis found in our cirrhotic patients is based on a recent study that reported gram-positive bacteria as a common cause of cellulitis in the general population, and not particularly in cirrhotics. To support our findings, relative literature has already been cited [1,2]. In a position statement, based on EASL special conference 2013, the role of bacterial translocation as cause for infection in cirrhotic patients has clearly been pointed out [3]. Dr. Basyigit posed the possibility that drug-resistant bacteria might emerge using antibiotic prophylaxis. Though it might be true, antibiotic prophylaxis is still being used to prevent conditions such as spontaneous bacterial peritonitis thereby reducing mortality. Finally, Dr. Basyigit claimed that antibiotic prophylaxis will lead to resistant microorganisms rather than prevention from skin infection. We strongly oppose this view because bacterial infection increases 3.75-fold the mortality of patients with decompensated cirrhosis, reaching a rate of 30% at 1 month and 63% at 1 year [3]. If we can prevent recurrence of bacterial cellulitis in cirrhotic patients as we have shown in our study, it might help reduce mortality. However, since we have not examined the benefit from the prevention of cellulitis recurrence on the mortality of cirrhotic patients, further studies are warranted to elucidate this issue.