IMPACT OF MICROBIOLOGICAL CHANGES ON SPONTANEOUS BACTERIAL PERITONITIS IN THREE DIFFERENT PERIODS OVER 17 YEARS

ABSTRACT BACKGROUND: Spontaneous bacterial peritonitis is a serious complication in cirrhotic patients, and changes in the microbiological characteristics reported in the last years are impacting the choice of antibiotic used for treatment. OBJECTIVE: The aim of the present study is to evaluate the changes in the epidemiology and bacterial resistance of the germs causing spontaneous bacterial peritonitis over three different periods over 17 years. METHODS: All cirrhotic patients with spontaneous bacterial peritonitis and positive culture of ascites fluid were retrospectively studied in a reference Hospital in Southern Brazil. Three periods were ramdomly evaluated: 1997-1998, 2002-2003 and 2014-2015. The most frequent infecting organisms and the sensitivity in vitro to antibiotics were registered. RESULTS: In the first period (1997-1998) there were 33 cases, the most common were: E. coli in 13 (36.11%), Staphylococcus coagulase-negative in 6 (16.66%), K. pneumoniae in 5 (13.88%), S. aureus in 4 (11.11%) and S. faecalis in 3 (8.33%). In the second period (2002-2003), there were 43 cases, the most frequent were: Staphylococus coagulase-negative in 16 (35.55%), S. aureus in 8 (17.77%), E. coli in 7 (15.55%) and K. pneumoniae in 3 (6.66%). In the third period (2014-2015) there were 58 cases (seven with two bacteria), the most frequent were: E. coli in 15 (23.1%), S. viridans in 12 (18.5%), K. pneumoniae in 10 (15.4%) and E. faecium 5 (7.7%). No one was using antibiotic prophylaxis. Considering all staphylococci, the prevalence increased to rates of the order of 50% in the second period, with a reduction in the third period evaluated. Likewise, the prevalence of resistant E. coli increased, reaching 14%. CONCLUSION: There was a modification of the bacterial population causing spontaneous bacterial peritonitis, with high frequency of gram-positive organisms, as well as an increase in the resistance to the traditionally recommended antibiotics. This study suggests a probable imminent inclusion of a drug against gram-positive organisms in the empiric treatment of spontaneous bacterial peritonitis.

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The pattern of microbial flora in Spontaneous bacterial peritonitis in Cirrhotic patients

Journal of Rawalpindi Medical College ◽

10.37939/jrmc/vol24.iss1.13 ◽

2020 ◽

pp. 62-67

Author(s):

Sehrish Jahan Asif ◽

Murataza Gondal ◽

Shahida Parveen ◽

Sumera Mushtaq ◽

Shumaila Awan ◽

...

Keyword(s):

Ascitic Fluid ◽

Spontaneous Bacterial Peritonitis ◽

Cross Sectional Study ◽

Cross Sectional ◽

E Coli ◽

Bacterial Peritonitis ◽

Serious Infection ◽

Culture Sensitivity ◽

Cirrhotic Patients ◽

Biochemical Examination

Background: Spontaneous bacterial peritonitis (SBP) is the bacterial infection of ascitic fluid in the absence of other apparent causes. It is the most prevalent and serious infection in cirrhosis and leads to significant morbidity and mortality. The frequency of SBP in hospitalized patients with cirrhosis varies from 7 to 23% in the west and it is around 33% in Pakistan. Our study aim was to determine the frequency of microbial organisms isolated from spontaneous bacterial peritonitis in cirrhotic patients. Material and Methods: We did a cross-sectional study at the Department of Medicine, Fauji Foundation Hospital Rawalpindi for 6 months. Cirrhosis was diagnosed on the bases of clinical, biochemical and ultrasonography findings. Peripheral blood samples were obtained for the evaluation of complete blood cell count, polymorphonuclear leukocyte count, albumin and coagulation parameters. At the same time, the patients underwent paracentesis and a 20ml ascitic fluid sample was taken for culture sensitivity along with routine biochemical examination from the pathology department lab at our hospital. Results: A total of 150 patients were enrolled according to the inclusion criteria of the study. The mean age (yrs) of patients was 32.3+9.31. The frequency and percentages of male and female patients were 70 (46.7) and 80 (53.3) respectively. Frequency and percentages of E Coli and streptococcal pneumonia were 94 (62.7) and 34 (22.7) respectively, whereas frequency and percentages of staph aureus and Klebsiella were 22 (14.7). Conclusion: SBP is quite common in patients with cirrhosis. It should be suspected in all such cases presenting with typical or atypical features. E Coli was the most common causative organisms in our study but gram-positive organisms were quite frequent as well. Keywords: SBP, Cirrhosis, Peritonitis.

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BACTERIOLOGY OF SPONTANEOUS BACTERIAL PERITONITIS

The Professional Medical Journal ◽

10.29309/tpmj/2007.14.04.4803 ◽

2020 ◽

Vol 14 (04) ◽

pp. 551-555

Author(s):

DILSHAD MUHAMMAD ◽

Aamir Husain ◽

MASOOD JAVED ◽

Abdul Qayyum ◽

MUHAMMAD NAEEM IQBAL

Keyword(s):

Klebsiella Pneumoniae ◽

Ascitic Fluid ◽

Spontaneous Bacterial Peritonitis ◽

Positive Culture ◽

E Coli ◽

Bacterial Peritonitis ◽

Source Of Infection ◽

Digestive Diseases ◽

Study Setting ◽

Culture Negative

Cirrhosis is a major cause of mortality worldwide and is the most common non neoplastic cause ofdeath among hepatobiliary and digestive diseases. Ascites is often among the first signs of de-compensation in patientswith chronic liver disease. Spontaneous Bacterial Peritonitis (SBP) (with out any source of infection) occurs in 30% ofpatients with ascites. Common causative organisms include escherichia coli, pneumococcus, Klebsiella and anaerobes.It has a 25% mortality and recurs in 70% of patients within a year. Objective: To determine the pathological agentscausing SBP in patients with liver cirrhosis. Design: Descriptive study. Setting: Medical Ward Allied and K.M. HospitalsFaisalabad. Period: From 17 Nov 2004 to 15 May 2005. Patients & Materials. Fifty patients of either sex havingcirrhosis of liver and ascites were included according to the criteria i.e ascitic fluid leukocyte count of >500 cells/L or>250 PMN, while results of bacterial cultures of ascitic fluid were pending. Results: Out of 50 patients, 27 (54%) weremales and 23 (46%) females. Mean age of whole the population was found to be 51±12.49) yrs. Classical spontaneousbacterial peritonitis was present in 27 patients and Culture Negative Neutrocytic Ascites (CNNA) in 23(46%) patients.Out of 50 patients, 27(54%) samples of ascitic fluid showed positive culture reports. E Coli was isolated in 9(18%)cases. Klebsiella pneumoniae in 6(12%), streptococcus pneumoniae 4(8%), staphylococcus aureus 2(4%),pseudomonas aeruginosa 2(4%). Acinobacter 2(4%) and proteus mirabilis 2(4%). E.Coli is the commonest organismfollowed by klebsiella pneumoniae.

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

Journal of Clinical Medicine ◽

10.3390/jcm11010227 ◽

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%.

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SPONTANEOUS BACTERIAL PERITONITIS

The Professional Medical Journal ◽

10.29309/tpmj/2006.13.02.5009 ◽

2006 ◽

Vol 13 (02) ◽

pp. 201-205

Author(s):

MUHAMMAD IMRAN ◽

Haroon-ur- Rashid ◽

SHOAIB NAIYAR HASHMI ◽

Assawar Hussain ◽

ASHFAQ ALTAF

Keyword(s):

Ascitic Fluid ◽

Spontaneous Bacterial Peritonitis ◽

Military Hospital ◽

Routine Examination ◽

E Coli ◽

Bacterial Peritonitis ◽

Cirrhotic Patients ◽

The Mean ◽

Culture Positive ◽

Culture Negative

Objective: To evaluate the prevalence, diagnostic criteria and microbialspectrum of spontaneous bacterial peritonitis (SBP) and its variants in cirrhotic patients with ascites. Design: A hospitalbased prospective study carried out in cirrhotic patients with ascites. Place and duration of Study: The study wasconducted in the Department of Medicine Military Hospital Rawalpindi during October 2000 to March 2002. Subjectand Methods: One hundred and eighty consecutive patients of cirrhotic liver between the ages of 20-65 yearspresenting with ascites reporting to outdoor patient department of Military Hospital Rawalpindi were included in thestudy. The diagnosis of cirrhosis was made on history, clinical examination and the ultrasonographic findings. Thesepatients were subjected to ascites fluid tap and the patients were divided into SBP and non-SBP groups in the light ofresults of ascitic fluid routine examination and culture. The SBP group was further categorized into culture positive SBP,culture negative neutrocytic ascites (CNNA) and bacterascites (BA) on the basis of culture results and total leukocytecount, absolute polymorphonuclear leukocyte count per cubic mm of ascitic fluid. Results: The study included 144males and 36 females having cirrhosis with ascites. The mean age of these patients was 52.32±7.87 years. On thebasis of routine examination and culture of tapped ascitic fluid from these cases 57 of 180(31.66%) patients werediagnosed to have SBP or its variants. In addition to classic SBP in 18(31.58%) patients, its variants namely culturenegative neutrocytic ascites and bacterascites were detected in 37(64.92%) and two (3.5%) cases respectively. E. coliwas the most frequently cultured organism. It was isolated in 12 cases of SBP (60%). In 4 cases (20%) Klebsiella wascultured whereas Proteus mirabilus and Streptococcus were reported in two cases (10%) each. Conclusion: This studyindicates that spontaneous bacterial peritonitis is common and potentially fatal complication in cirrhotic patients withascites. E. coli is the most frequent offending organism.

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Spontaneous Bacterial Peritonitis in Cirrhotic Patients: A Shift in the Microbial Pattern? A Retrospective Analysis

GE Portuguese Journal of Gastroenterology ◽

10.1159/000518585 ◽

2021 ◽

pp. 1-11

Author(s):

Raquel Pimentel ◽

Jorge Leitão ◽

Carlos Gregório ◽

Lélita Santos ◽

Armando Carvalho ◽

...

Keyword(s):

Spontaneous Bacterial Peritonitis ◽

Gram Negative Bacteria ◽

Third Generation ◽

Gram Positive ◽

Gram Negative ◽

Bacterial Peritonitis ◽

Gram Positive Bacteria ◽

Cirrhotic Patients ◽

Empirical Antibiotics ◽

Third Generation Cephalosporins

Introduction: Over the last decade, a shift in the spontaneous bacterial peritonitis (SBP) microbial pattern toward an increasing incidence of gram-positive and multidrug-resistant (MDR) bacteria has been reported. Systematic surveillance of the local microbiological scenario and antibiotic resistance is crucial to SBP treatment success. The main objective of this study was to evaluate the microbiological profile and bacterial resistance of SBP pathogens in a Portuguese cohort to allow selection of the most appropriate empirical antibiotics. Methods: This is a single-center retrospective study including 63 adult cirrhotic patients with culture-positive SBP. Patients were identified using a hospital general diagnostic database and searching for all SBP events (neutrophil count in ascitic fluid ≥250/mm3) from January 1, 2012, to December 31, 2017. Patients were excluded if they had culture-negative SBP, secondary peritonitis, peritoneal dialysis, a liver transplant, or immunodeficiency. The site of SBP acquisition was classified as nosocomial if it was diagnosed 48 h or longer after hospitalization or as nonnosocomial if it was diagnosed within the first 48 h. MDR bacteria were those with an acquired resistance to at least 1 agent in 3 or more antimicrobial categories. All statistical analyses were carried out using IBM SPSS Statistics software version 22 (IBM, New York, USA). Results: The study cohort comprised 53 (84.1%) men. The mean age of the patients was 60.6 ± 11.2 years. Alcohol was the most common etiology (88.9%) and most patients had advanced liver cirrhosis (87.1%, Child C). Gram-negative bacteria were slightly more frequent than gram-positive bacteria (56.9 vs. 43.1%). Escherichia coli was the most common pathogen (33.8%). Nineteen (31.7%) bacteria were classified as MDR. Resistance to third-generation cephalosporins, quinolones, piperacillin-tazobactam, and carbapenems was found in 31.7, 35, 26.7, and 18.3% of the cases, respectively. The rates of gram-positive bacteria were similar between nosocomial and nonnosocomial episodes (45 vs. 42.2%; p = 0.835). MDR bacteria were more common in the nosocomial group (50 vs. 23.8%; p = 0.046). Resistance to third-generation cephalosporins (50 vs. 23.8%; p = 0.046), piperacillin-tazobactam (44.4 vs. 19.1%; p = 0.041), and carbapenems (33.3 vs. 11.9%; p = 0.049) occurred more frequently in nosocomial episodes. Resistance to first-line antibiotic occurred in 29.3% of the patients, being more common in the nosocomial group (44.4 vs. 22.5%; p = 0.089). Conclusion: Although gram-negative bacteria remain the most common causative microorganisms, our results emphasize the shift in SBP microbiological etiology, as almost half of the isolated microorganisms were gram positive. The emergence of bacteria resistant to traditionally recommended empirical antibiotics underlines the importance of basing this choice on local flora and antibiotic susceptibility data, allowing a more rational and successful use of antibiotics.

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Effective Small Molecule Antibacterials from a Novel Anti-Protein Secretion Screen

Microorganisms ◽

10.3390/microorganisms9030592 ◽

2021 ◽

Vol 9 (3) ◽

pp. 592

Author(s):

Mohamed Belal Hamed ◽

Ewa Burchacka ◽

Liselotte Angus ◽

Arnaud Marchand ◽

Jozefien De Geyter ◽

...

Keyword(s):

Protein Secretion ◽

Small Molecule ◽

Bacterial Resistance ◽

Bacterial Species ◽

Attractive Potential ◽

Gram Positive ◽

Gram Negative ◽

E Coli ◽

Gram Positive Bacteria

The increasing problem of bacterial resistance to antibiotics underscores the urgent need for new antibacterials. Protein export pathways are attractive potential targets. The Sec pathway is essential for bacterial viability and includes components that are absent from eukaryotes. Here, we used a new high-throughput in vivo screen based on the secretion and activity of alkaline phosphatase (PhoA), a Sec-dependent secreted enzyme that becomes active in the periplasm. The assay was optimized for a luminescence-based substrate and was used to screen a ~240K small molecule compound library. After hit confirmation and analoging, 14 HTS secretion inhibitors (HSI), belonging to eight structural classes, were identified with IC50 < 60 µM. The inhibitors were evaluated as antibacterials against 19 Gram-negative and Gram-positive bacterial species (including those from the WHO’s top pathogens list). Seven of them—HSI#6, 9; HSI#1, 5, 10; and HSI#12, 14—representing three structural families, were bacteriocidal. HSI#6 was the most potent hit against 13 species of both Gram-negative and Gram-positive bacteria with IC50 of 0.4 to 8.7 μM. HSI#1, 5, 9 and 10 inhibited the viability of Gram-positive bacteria with IC50 ~6.9–77.8 μM. HSI#9, 12, and 14 inhibited the viability of E. coli strains with IC50 < 65 μM. Moreover, HSI#1, 5 and 10 inhibited the viability of an E. coli strain missing TolC to improve permeability with IC50 4 to 14 μM, indicating their inability to penetrate the outer membrane. The antimicrobial activity was not related to the inhibition of the SecA component of the translocase in vitro, and hence, HSI molecules may target new unknown components that directly or indirectly affect protein secretion. The results provided proof of the principle that the new broad HTS approach can yield attractive nanomolar inhibitors that have potential as new starting compounds for optimization to derive potential antibiotics.

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