Sa1018 Risk Factors for Resistance to Third-Generation Cephalosporin and Its Clinical Outcomes in Cirrhotic Patients Presenting With Spontaneous Bacterial Peritonitis

2015 ◽  
Vol 148 (4) ◽  
pp. S-1008
Author(s):  
Kraisingh Kuljiratitikal ◽  
Phunchai Charatcharoenwitthaya
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Spontaneous Bacterial Peritonitis ◽  
Generation Cephalosporin ◽  
Third Generation ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients

scholarly journals High Prevalence of Multidrug Resistant Bacteria in Cirrhotic Patients with Spontaneous Bacterial Peritonitis: Is It Time to Change the Standard Antimicrobial Approach?

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Jerônimo De Conto Oliveira ◽  
Enrique Carrera ◽  
Roberta C. Petry ◽  
Caroline Deutschendorf ◽  
Augusto Mantovani ◽  
...  
Keyword(s):  
Ascitic Fluid ◽  
Spontaneous Bacterial Peritonitis ◽  
Generation Cephalosporin ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Bacterial Peritonitis ◽  
High Prevalence ◽  
Cirrhotic Patients ◽  
End Stage

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.

Risk factors for development of spontaneous bacterial peritonitis and subsequent mortality in cirrhotic patients with ascites

2015 ◽  
Vol 35 (9) ◽  
pp. 2121-2128 ◽  
Author(s):  
Philipp Schwabl ◽  
Theresa Bucsics ◽  
Kathrin Soucek ◽  
Mattias Mandorfer ◽  
Simona Bota ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spontaneous Bacterial Peritonitis ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients

Risk factors for spontaneous bacterial peritonitis in cirrhotic patients with ascites

1993 ◽  
Vol 104 (4) ◽  
pp. 1133-1138 ◽  
Author(s):  
Montserrat Andreu ◽  
Ricard Sola ◽  
Antonio Sitges-Serra ◽  
Concepcion Alia ◽  
Manuel Gallen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spontaneous Bacterial Peritonitis ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients

scholarly journals Third-Generation Cephalosporin-Resistant Spontaneous Bacterial Peritonitis: A single-Centre Experience and Summary of Existing Studies

2014 ◽  
Vol 28 (2) ◽  
pp. 83-88 ◽  
Author(s):  
Jennifer Chaulk ◽  
Michelle Carbonneau ◽  
Hina Qamar ◽  
Adam Keough ◽  
Hsiu-Ju Chang ◽  
...  
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Tertiary Care ◽  
Generation Cephalosporin ◽  
Care Hospital ◽  
Third Generation ◽  
Bacterial Peritonitis ◽  
Common Diagnosis ◽  
Cephalosporin Resistance ◽  
Third Generation Cephalosporins ◽  
Culture Positive

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is the most prevalent bacterial infection in patients with cirrhosis. Although studies from Europe have reported significant rates of resistance to third-generation cephalosporins, there are limited SBP-specific data from centres in North America.OBJECTIVE: To evaluate the prevalence of, predictors for and clinical impact of third-generation cephalosporin-resistant SBP at a Canadian tertiary care centre, and to summarize the data in the context of the existing literature.METHODS: SBP patients treated with both antibiotics and albumin therapy at a Canadian tertiary care hospital between 2003 and 2011 were retrospectively identified. Multivariate logistic regression was used to determine independent predictors of third-generation cephalosporin resistance and mortality.RESULTS: In 192 patients, 25% of infections were nosocomial. Forty per cent (77 of 192) of infections were culture positive; of these, 19% (15 of 77) were resistant to third-generation cephalosporins. The prevalence of cephalosporin resistance was 8% with community-acquired infections, 17% with health care-associated infections and 41% with nosocomial acquisition. Nosocomial acquisition of infection was the only predictor of resistance to third-generation cephalosporins (OR 4.0 [95% CI 1.04 to 15.2]). Thirty-day mortality censored for liver transplantation was 27% (50 of 184). In the 77 culture-positive patients, resistance to third-generation cephalosporins (OR 5.3 [1.3 to 22]) and the Model for End-stage Live Disease score (OR 1.14 [1.04 to 1.24]) were independent predictors of 30-day mortality.CONCLUSIONS: Third-generation cephalosporin-resistant SBP is a common diagnosis and has an effect on clinical outcomes. In an attempt to reduce the mortality associated with resistance to empirical therapy, high-risk subgroups should receive broader empirical antibiotic coverage.

scholarly journals Prognostic Factors Associated with Mortality in Cirrhotic Patients with Bleeding Varices

2019 ◽  
Vol 5 (02) ◽  
pp. 46-52
Author(s):  
Alshaimaa Fathy Eldesouky ◽  
Mohamed Abd Elraoof Tawfik ◽  
Maha Mahmoud Hagras ◽  
Taher Eldemerdash Attia ◽  
Mohammed Elsayed Elhendawy
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Hepatic Encephalopathy ◽  
Serum Creatinine ◽  
Variceal Bleeding ◽  
Death Rate ◽  
Spontaneous Bacterial Peritonitis ◽  
Apache Ii ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients

Abstract Objective Bleeding gastroesophageal varices are a cause of high mortality among cirrhotic patients. Aim The aim of this study was to study prognostic factors for mortality in cirrhosis associated with variceal bleeding. Patients and Methods This prospective study was conducted on 100 cirrhotic patients admitted to the Tanta University Hospital with an acute first variceal bleeding episode. Baseline clinical, laboratory, and endoscopic findings were recorded at presentation. Results During the first 6 weeks 15 patients died, 3 following the initial bleed and 12 after an early rebleed. At 6 months, a further 21 patients had died. Statistical analysis utilizing the baseline data revealed that high early death rate was associated with number of blood units transfused, lower systolic blood pressure, thrombocytopenia, increased serum creatinine and international normalized ratio (INR). High MELD, AIMS56, acute physiology and chronic health evaluation II (APACHE II) and ROCKall scores were risk factors for mortality. Risk factors for early rebleeding included presence of diabetes mellitus, leucocytosis, high Child score, model for end-stage liver disease (MELD), AIMS56, and sepsis-associated organ failure assessment (SOFA) scores. A high Child score, presence of ascites, and associations such as hepatic encephalopathy and spontaneous bacterial peritonitis, leucocytosis, elevated alanine transaminase, aspartate transaminase, bilirubin, INR, and creatinine as well as low albumin were associated with decreased survival. Conclusion High MELD, AIMS56, APACHE II, and ROCKall scores were risk factors for mortality after acute variceal bleeding. High death rate during the first 6 weeks is associated with anemia, hypotension, thrombocytopenia, increased serum creatinine, and INR. Decreased survival at 6 months is associated with increased Child score, presence of ascites and associations such as hepatic encephalopathy and spontaneous bacterial peritonitis.

scholarly journals Spontán bakteriális peritonitis

2017 ◽  
Vol 158 (2) ◽  
pp. 50-57
Author(s):  
Bálint Velkey ◽  
Eszter Vitális ◽  
Zsuzsanna Vitális
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Antibiotic Sensitivity ◽  
Antibiotic Use ◽  
Primary Prophylaxis ◽  
Generation Cephalosporin ◽  
Secondary Prophylaxis ◽  
Bacterial Peritonitis ◽  
Gram Positive Bacteria ◽  
Amoxicillin Clavulanic Acid ◽  
Cirrhotic Patients

Abstract: Spontaneous bacterial peritonitis occurs most commonly in cirrhotic patients with ascites. Pathogens get into the circulation by intestinal translocation and colonize in peritoneal fluid. Diagnosis of spontaneous bacterial peritonitis is based on elevated polymorphonuclear leukocyte count in the ascites (>0,25 G/L). Ascites culture is often negative but aids to get information about antibiotic sensitivity in positive cases. Treatment in stable patient can be intravenous then orally administrated ciprofloxacin or amoxicillin/clavulanic acid, while in severe cases intravenous III. generation cephalosporin. Nosocomial spontaneous bacterial peritonitis often caused by Gram-positive bacteria and multi-resistant pathogens can also be expected thus carbapenem should be the choice of the empiric treatment. Antibiotic prophylaxis should be considered. Norfloxacin is used most commonly, but changes are expected due to increase in quinolone resistance. As a primary prophylaxis, a short-term antibiotic treatment is recommended after gastrointestinal bleeding for 5 days, while long-term prophylaxis is for patients with low ascites protein, and advanced disease (400 mg/day). Secondary prophylaxis is recommended for all patients recovered from spontaneous bacterial peritonitis. Due to increasing antibiotic use of antibiotics prophylaxis is debated to some degree. Orv. Hetil., 2017, 158(2), 50–57.

scholarly journals Spontaneous Bacterial Peritonitis among Cirrhotic Patients: Prevalence, Clinical Characteristics, and Outcomes

2021 ◽  
Vol 11 (1) ◽  
pp. 227
Author(s):  
Naim Abu-Freha ◽  
Tal Michael ◽  
Liat Poupko ◽  
Asia Estis-Deaton ◽  
Muhammad Aasla ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ascitic Fluid ◽  
Spontaneous Bacterial Peritonitis ◽  
Cox Regression ◽  
Positive Culture ◽  
Multidrug Resistant ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients ◽  
Escherichia Coli Bacteria

(1) Background: Spontaneous bacterial peritonitis (SBP) is a feared complication of liver cirrhosis. We investigated the prevalence of SBP, positive ascitic fluid cultures, and risk factors for mortality. (2) Methods: A retrospective analysis of all patients with cirrhosis hospitalized or in follow-up in a single center between 1996 and 2020. The clinical data, long-term complications, and mortality of SBP patients were compared with those of non-SBP patients. Ascitic fluid positive culture was compared with those without growth. (3) Results: We included 1035 cirrhotic patients, of which 173 (16.7%) developed SBP. Ascitic fluid culture growth was found in 47.4% of the SBP cases, with Escherichia coli bacteria detected in 38%, 24.4% grew ESBL-producing bacteria, and 14.5% displayed multidrug resistance. In a Cox regression model, SBP, male sex, prolonged INR at diagnosis, and hepatocellular carcinoma were found to be risk factors for mortality in cirrhotic patients. The long-term all-cause mortality was 60% in non-SBP and 90% in SBP patients. (4) Conclusions: Only a minority of cirrhotic patients developed SBP, 47.4% of which had positive ascitic fluid cultures with high antibiotic resistance. Growth of ESBL and multidrug resistant organisms is becoming more frequent in the clinical setting, reaching SBP mortality of 90%.

Sign in / Sign up

Export Citation Format

Share Document