High prevalence of drug resistant bacterial isolates from ascitic fluid among cirrhotic patients with spontaneous bacterial peritonitis, from a tertiary care hospital in India

Introduction. Spontaneous bacterial peritonitis (SBP) has a deleterious clinical impact in end-stage liver disease, and multidrug resistance has increased, raising concern about effectiveness of traditional antibiotic regimens. Patients and Methods. Single-center retrospective study of ascitic fluid infections in cirrhotic patients. Results. We analyzed medical records related to 2129 culture-positive ascitic fluid and found 183 samples from cirrhotic patients. There were 113 monobacterial SBP cases from 97 cirrhotic patients; 57% of patients were male; hepatitis C and alcohol were the main etiologies for cirrhosis. Multidrug resistant bacteria were isolated in 46.9% of SBP samples, and third-generation cephalosporin and quinolone resistant reached 38.9% and 25.7% of SBP cases. Conclusion. SBP due to multidrug resistant bacteria is a growing problem, and one should consider reported resistance profiles for the decision-making process of empirical first-line treatment prescription.

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Combination of vial culture and broad-range PCR for the diagnosis of spontaneous bacterial peritonitis: experience in a Greek tertiary care hospital

New Microbes and New Infections ◽

10.1016/j.nmni.2018.12.001 ◽

2019 ◽

Vol 28 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

E. Malli ◽

N.K. Gatselis ◽

G.N. Dalekos ◽

E. Petinaki

Keyword(s):

Spontaneous Bacterial Peritonitis ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Bacterial Peritonitis

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Clinico-bacteriological profile of spontaneous bacterial peritonitis in cirrhosis of liver with ascites

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20194622 ◽

2019 ◽

Vol 7 (11) ◽

pp. 4256

Author(s):

Shewtank Goel ◽

Pooja Tripathi Pandey ◽

Abhay Kumar ◽

Nidhish Kumar ◽

Deval Kumar Arora ◽

...

Keyword(s):

Ascitic Fluid ◽

Spontaneous Bacterial Peritonitis ◽

Tertiary Care ◽

Coagulase Negative Staphylococcus ◽

Bacterial Peritonitis ◽

Rebound Tenderness ◽

Fluid Analysis ◽

Cirrhotic Patients ◽

Cirrhosis Of Liver ◽

Culture Negative

Background: A good and an effective empirical treatment of SBP is not possible unless bacteriological spectrum and their antibiogram is clear. This becomes more important in country like India due to high antibiotic resistance. Authors aim was to assess the prevalence of SBP, clinical and microbiological profile of its variants, in patients with cirrhosis seeking care at a tertiary care teaching hospital.Methods: Patients of liver cirrhosis with ascites seeking care at study subject during January- December 2018 formed the study population. Diagnosis was based on clinical examination, biochemical investigation and ultrasonography. Diagnostic abdominal paracentesis was performed on subjects within 24 hours of admission. Ascitic fluid was aspirated. It was sent for microbiological examination.Results: Prevalence of SBP was 16.12%. Out of total ten subjects with Spontaneous Bacterial Peritonitis (SBP), six subjects were of Culture Negative Neutrocytic Ascites (CNNA). Thus most common (60%), variant of Spontaneous Bacterial Peritonitis (SBP) was Culture Negative Neutrocytic Ascites (CNNA). Prevalence of Mono-microbial Non-neutrocytic Bacterascites (MNBA) and Classic-Spontaneous Bacterial Peritonitis (C-SBP) was 20%. Two subjects found positive for MNBA, Staphylococcus aureus and Acinitobacter spp. was detected in each patient. Klebseila pneumonia, Escherichia coli and Coagulase negative Staphylococcus were found in ascitic fluid culture of C-SBP. In clinical variants of SBP, 80% subject’s complaint about abdominal pain. Hepatic-encephalopathy and fever was seen in 7(70%) patients. Rebound tenderness was seen among 60%.Conclusions: Diagnostic paracentesis should be advised to all cirrhotic patients with ascites. Ascitic fluid analysis should be sent for better selection of antibiotics thus better outcome of cirrhotic patients.

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Study of etiology, clinical profile and predictive factors of spontaneous bacterial peritonitis in cirrhosis of liver

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20172096 ◽

2017 ◽

Vol 5 (6) ◽

pp. 2326

Author(s):

Juhi B. Kawale ◽

Kavita J. Rawat

Keyword(s):

Hepatic Encephalopathy ◽

Ascitic Fluid ◽

Spontaneous Bacterial Peritonitis ◽

Strong Association ◽

Tertiary Care ◽

High Serum ◽

Polymorphonuclear Leucocyte ◽

Care Hospital ◽

Bacterial Peritonitis ◽

Cirrhosis Of Liver

Background: Spontaneous bacterial peritonitis (SBP) is one of the potentially lethal complication of liver cirrhosis and is defined as infected ascites in the absence of any recognizable secondary cause of infection. Majority of the SBP cases are caused by organism from the gastrointestinal tract mainly aerobic gram-negative organisms- Escherichia coli being the most common etiological agent.Methods: It was a prospective observational study done over a period of 1 year in a tertiary care hospital. 50 patients from medical and gastroenterology wards were included in the study. Patients above 12 year of age with diagnosed cirrhosis of liver and documented evidence of SBP were included. Pregnant females, patients who refused to give consent, patients with a documented evidence of intra-abdominal source of infection or patients with ascitis due to non-hepatic causes were excluded.Results: The high serum bilirubin and creatinine levels were associated with higher mortality rate. Hepatic encephalopathy is associated with worse outcome. The outcome of the patient in relation to the grades of ascitis, liver enzymes, prothrombin time, international normalised ratio (INR), Child pugh grades, ascitic fluid polymorphonuclear leucocyte count, ascitic fluid culture and blood culture were not statistically significant.Conclusions: A high index of suspicion should exist for SBP in patients with cirrhosis and ascitis. Serum creatinine and bilirubin levels are strong predictors of mortality. Hepatic encephalopathy has a strong association with mortality in patients with spontaneous bacterial peritonitis.

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High prevalence of multidrug resistant uropathogens: A recent audit of antimicrobial susceptibility testing from a tertiary care hospital in Bangladesh

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.6.2943 ◽

2020 ◽

Vol 36 (6) ◽

Author(s):

Chandrika Dasgupta ◽

Md. Abdur Rafi ◽

Md. Abdus Salam

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Antimicrobial Susceptibility ◽

Susceptibility Testing ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Drug Resistant ◽

High Prevalence ◽

Tract Infections

Objectives: Urinary tract infections due to multi drug resistant bacteria have been on the rise globally with serious implications for public health. The objective of this study was to explore the prevalence of multi drug resistant uropathogens and to correlate the urinary tract infections with some demographic and clinical characteristics of patients admitted in a tertiary care hospital in Bangladesh. Methods: A cross sectional prospective study was conducted at Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh among clinically suspected urinary tract infection patients from January to December, 2018. Clean-catch midstream or catheter-catch urine samples were subjected to bacteriological culture using chromogenic agar media. Antimicrobial susceptibility testing of the isolates was done by Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. Descriptive statistical methods were used for data analysis. Results: Culture yielded a total of 537 (42.8%) significant bacterial growths including 420 (78.2%) multi drug resistant uropathogens from 1255 urine samples. Escherichia coli was the most common isolate (61.6%) followed by Klebsiella spp. (22.5%), Pseudomonas spp. (7.8%), Staphylococcus aureus (5.4%) and Enterobacter spp. (2.6%) with multi drug resistance frequency of 77.6%, 71.9%, 90.5%, 86.2% and 92.9% respectively. There was female preponderance (M:F; 1:1.97; P=0.007) but insignificant differences between paediatric and adult population (43.65% vs. 42.57%) and also among different age groups. Diabetes, chronic renal failure, fever and supra-pubic pain had significant association as co-morbidities and presentations of urinary tract infections (P<0.05). Multi drug resistance ranged from 3.7 to 88.1% including moderate to high resistance found against commonly used antibiotics like ciprofloxacin, cephalosporin, azithromycin, aztreonam, cotrimoxazole and nalidixic acid (28.6 to 92.9%). Isolates showed 2.4 to 32.2% resistance to nitrofurantoin, amikacin, netilmicin and carbapenems except Pseudomonas spp. (66.7% resistance to nitrofurantoin) and Enterobacter spp. (28.6 to 42.9% resistance to carbapenems). Conclusion: There is very high prevalence of multi drug resistant uropathogens among hospitalized patients and emergence of carbapenem resistance is an alarming situation. Antibiotic stewardship program is highly recommended for hospitals to combat antimicrobial resistance. doi: https://doi.org/10.12669/pjms.36.6.2943 How to cite this:Dasgupta C, Rafi MA, Salam MA. High prevalence of multidrug resistant uropathogens: A recent audit of antimicrobial susceptibility testing from a tertiary care hospital in Bangladesh. Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.2943 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Serial Ascitic Fluid Analysis – Prognostic Marker for Adverse Outcome in Spontaneous Bacterial Peritonitis in Liver Cirrhosis?

Journal of Advances in Internal Medicine ◽

10.3126/jaim.v4i1.14174 ◽

2015 ◽

Vol 4 (1) ◽

pp. 6-12

Author(s):

Rahul Pathak ◽

Annette Von Thun ◽

Kumar Vikram Singh ◽

Prem Khadga ◽

Shashi Sharma

Keyword(s):

Ascitic Fluid ◽

Repeated Measures ◽

Spontaneous Bacterial Peritonitis ◽

Hospital Admissions ◽

Tertiary Care ◽

Roc Curves ◽

Predictive Values ◽

Bacterial Peritonitis ◽

Fluid Analysis ◽

Cirrhotic Patients

Background: Cirrhosis is a frequent cause of hospital admissions in Nepal with spontaneous bacterial peritonitis (SBP) being a major determinant of mortality. Limited diagnostic options preclude early risk stratification to improve patient outcomes. We assessed the predictive value of polymorphonuclear leukocyte counts (PMNs) and its association with mortality in hospitalized SBP patients.Methods: We examined 51 cirrhotic patients diagnosed with SBP in a prospective case-control study admitted to a Nepali tertiary care facility from February 2010 to November 2012. Serial paracentesis and ascitic fluid analysis were performed at admission, 24, and 48 hours. Receiver operating characteristic (ROC) curves, repeated measures analysis of variance, and logistic regression evaluated ascitic PMNs as predictors of mortality.Results: Deceased patients demonstrated significantly elevated mean circulating and ascitic PMNs. Ascitic PMNs in the non-survivors were significantly elevated upon admission and at 24 and 48 hours. These differences were significant based on absolute counts, relative differences and trends across time. ROC curves provided diagnostic thresholds (1600, 860, 500 cells/mm3) distinguishing the two groups upon presentation, at 24 and 48 hours respectively, with high sensitivities (100%), specificities (82.5-97.5%), and positive predictive values (52.4-84.6%). After adjusting for age and case severity, there was a 9.1-fold greater odds of mortality upon admission, for every increase of 500 ascitic PMNs.Conclusion: In this study of cirrhotic patients with SBP, in-hospital mortality was associated with persistently elevated ascitic PMNs. Ascites PMN thresholds offer a quick, low-tech option to risk stratify patients, prognosticate mortality, and guide patient care in low resourced settings. Journal of Advances in Internal Medicine 2015;04(01):6-12

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