Prevalence and predictors of spontaneous bacterial peritonitis in cirrhotic patients unresponsive to third generation cephalosporins in Prapokklao Hospital
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Abstract
Background: Spontaneous bacterial peritonitis (SBP) is one of the common infections in cirrhotic patients with ascites. SBP is typically caused by gram-negative bacteria. There has been an increase in the number of SBP cases caused by third generation cephalosporin-resistant bacteria nowadays.
Objectives: To study the prevalence and predictors of third generation cephalosporin-unresponsive (resistance) SBP in Prapokklao Hospital; to study the prevalence and type of third generation cephalosporin-resistant organisms, and to study the mortality rate and its predictors.
Materials and Methods: A retrospective study of the cirrhotic patients with SBP admitted from October 2013 to December 2018 in Prapokklao Hospital. Patient characteristics, clinical presentation, treatments, and outcomes were collected. Binary logistic regression analysis was used to identify the predictors of third generation cephalosporin-unresponsive SBP.
Results: We identified 93 cirrhotic patients with SBP. The prevalence of third generation cephalosporin-unresponsive SBP was 23.7%, while 26.9% of infections were culture-positive SBP. The most common third generation cephalosporin-resistant organism was ESBL-producing Escherichia coli at 32%, followed by Enterococcus spp. at 12%. The most common third generation cephalosporin-resistant organism isolated from blood culture was also ESBL-producing Escherichia coli at 18.8%, followed by Enterococcus sp., ESBL-producing Klebsiella pneumoniae at 6.3%. An independent predictor of third generation cephalosporin-resistant SBP was the use of third generation cephalosporin antibiotics in the past 90 days (OR 3.89, 95% CI 1.33-11.36). All cause mortality rate was 18.3%. An independent predictor for mortality was the INR greater than 2.2 at the time of diagnosis of SBP (OR 5.20, 95% CI 1.18-22.99).
Conclusion: The history of third generation cephalosporin usage in the past 90 days helps clinicians to identify cirrhotic patients with SBP who should receive broader empirical antibiotics that can cover third generation cephalosporin-resistant pathogens.
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References
Kim JH, Jeon YD, Jung IY, Ahn MY, Ahn HW, Ahn JY, et al. Predictive factors of spontaneous bacterial peritonitis caused by gram-positive bacteria in patients with cirrhosis. Medicine (Baltimore)[Internet]. 2016 [cited 2019 Nov 10];95:e3489. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998712/pdf/medi-95-e3489.pdf
Sarwar S, Tarique S, Waris U, Khan AA. Cephalosporin resistance in community acquired spontaneous bacterial peritonitis. Pak J Med Sci 2019;35:4-9.
Sofjan AK, Musgrove RJ, Beyda ND, Russo HP, Lasco TM, Yau R, et al. Prevalence and predictors of spontaneous bacterial peritonitis due to ceftriaxone-resistant organisms at a large tertiary centre in the USA. J Glob Antimicrob Resist 2018;15:41-7.
Chaulk J, Carbonneau M, Qamar H, Keough A, Chang H, Ma M, et al. Third-generation cephalosporin-resistant spontaneous bacterial peritonitis: a single-centreexperience and summary of existing studies. Can J GastroenterolHepatol 2014;28:83-8.
Sajjad M, Khan ZA, Khan MS. Ascitic fluid culture in cirrhotic patients with spontaneous bacterial peritonitis. J Coll Physicians Surg Pak 2016;26:658–61.
European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatolo 2018;69:406-60.
Niu B, Kim B, Limketkai BN, Sun J, Li Z, Woreta T, et al. Mortality from Spontaneous bacterial peritonitis among hospitalized patients in the USA. Dig Dis Sci. 2018;63:1327-33.
Lolekha P, Chunlertrith K. Spontaneous bacterial peritonitis, causes and antibiotic usage in Srinagarind Hospital. J Med Assoc Thai 2001;84:995-9.