Cephalosporin resistance in community acquired spontaneous bacterial peritonitis

Shahid Sarwar, Shandana Tarique, Umaima Waris, Anwaar A Khan, Shahid Sarwar, Shandana Tarique, Umaima Waris, Anwaar A Khan

Abstract

Objective: To determine 3rd generation cephalosporin resistance in patients with community-acquired spontaneous bacterial peritonitis (SBP) using early response assessment.

Methods: This prospective quasi-experimental study was carried out at Doctors Hospital & Medical Center from January 2016 to September 2018. Patients with cirrhosis and SBP were included. Third generation cephalosporins i.e. cefotaxime/ceftriaxone were used for treatment of SBP. Response after 48 hours was assessed and decline in ascitic fluid neutrophil count of < 25% of baseline was labelled as cephalosporin resistant. Carbapenem were used as second line treatment. Recovery and discharge or death of patients were primary end points.

Results: Male to female ratio in 31 patients of SBP was 1.2/1 (17/14). Hepato-renal syndrome was diagnosed in 11(37.9%) patients. Cefotaxime was used for 16(51.6%) patients whereas ceftriaxone for 15(48.3%) patients. Early response of SBP was noted in 26(83.8%) patients while 5 (16.2%) were non-responders to cephalosporins. SBP resolved in all non-responding patients with i/v carbapenem. In-hospital mortality was 12.9% and had no association with cephalosporin resistance. High bilirubin (p 0.04), deranged INR (p 0.008), low albumin (p 0.04), high Child Pugh (CTP) score (p 0.03) and MELD scores (p 0.009) were associated with in-hospital mortality.

Conclusion: Cephalosporin resistance was present in 16.2% of study patients with community-acquired SBP. Mortality in SBP patients is associated with advanced stage of liver disease.

Keywords: Cephalosporins; In-hospital mortality; Resistance; Spontaneous bacterial peritonitis.

Conflict of interest statement

Conflict of Interest: None to declare.

References

    1. Caly WR, Strauss E. A prospective study of bacterial infections in patients with cirrhosis. J Hepatol. 1993;18:353–358. doi:10.1016/s0168-8278(05)80280-6.
    1. Arvaniti V, D'Amico G, Fede G, Manousou P, Tsochatzis E, Pleguezuelo M, et al. Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis. Gastroenterology. 2010;139:1246–1256. doi:10.1053/j.gastro.2010.06.019.
    1. Leber B, Spindelboeck W, Stadlbauer V. Infectious complications of acute and chronic liver disease. Semin Respir Crit Care Med. 2012;33:80–95. doi:10.1055/s-0032-1301737.
    1. Gaetano JN, Micic D, Aronsohn A, Reddy G, Te H, Reau NS, et al. The benefit of paracentesis on hospitalized adults with cirrhosis and ascites. J Gastroenterol Hepatol. 2016;31:1025–1030. doi:10.1111/jgh.13255.
    1. Kim JJ, Tsukamoto MM, Mathur AK, Ghomri YM, Hou LA, Sheibani S, et al. Delayed paracentesis is associated with increased in-hospital mortality in patients with spontaneous bacterial peritonitis. Am J Gastroenterol. 2014;109:1436–1442. doi:10.1038/ajg.2014.212.
    1. Friedrich K, Nussle S, Rehlen T, Stremmel W, Mischinik A, Eisenback C. Microbiology and resistance in first episodes of spontaneous bacterial peritonitis:Implications for management and prognosis. J Gastroenterol Hepatol. 2016;31:1191–1195. doi:10.1111/jgh.13266.
    1. Karvellas CJ, Abraldes J, Arabi YM, Kumar A Cooperative antimicrobial therapy of septic shock (CATSS) Database Research Group. Appropriate and timely antimicrobial therapy in cirrhotic patients with spontaneous bacterial peritonitis-associated septic shock:a retrospective cohort study. Aliment Pharmacol Ther. 2015;41:747–757. doi:10.1111/apt.13135.
    1. Runyon BA Practice guideline. Management of adult patients with ascites due to cirrhosis:Update. 2012. [Retrieved September 3, 2018]. .
    1. Fernandez J, Bert F, Nicolas-Chanoine MH. The challenges of multidrug-resistance in hepatology. J Hepatol. 2016;65:1043–1054. doi:10.1016/j.jhep.2016.08.006.
    1. Angeli P, Bernardi M, Villanueva C, Francoz C, Mookerjee RP, Trebicka J, et al. EASL Clinical practice Guidelines for the management of patients with decompensated liver disease. J Hepatol. 2018;69:406–460. doi:10.1016/j.jhep.2018.03.024.
    1. Shaikh BT. Anti-Microbial Resistance In Pakistan:A Public Health Issue. J Ayub Med Coll Abbottabad. 2017;29(2):184–185.
    1. Falagas ME, Karageorgopoulos DE. Pandrug resistance (PDR), Extensive drug resistance (XDR) and Multidrug resistance (MDR) among gram negative bacilli:Need for international harmonization in terminology. Clinic Inf Diseases. 2008;46(7):1121–1122. doi:10.1086/528867.
    1. Chaulk J, Carbonneau M, Qaar H, Keough A, Chang HJ, Ma M, et al. Third generation cephalosporin-resistant spontaneous bacterial peritonitis:a single centre experience and summary of existing studies. Can J Gastroenterol Hepatol. 2014;28(2):83–88. doi:10.1155/2014/429536.
    1. Alexopoulou A, Papadopoulos N, Eliopoulos DG, Alexaki A, Tsiriga A, Toutouza M, et al. Increasing frequency of gram-positive cocci and gram negative multidrug-resistant bacteria in spontaneous bacterial peritonitis. Liv Int. 2013;33(7):975–981. doi:10.1111/liv.12152.
    1. Novovic S, Semb S, Olsen H, Moser Knudsen JD, Homann C. First line treatment with cephalosporins in spontaneous bacterial peritonitis provides poor antibiotic coverage. Scand J Gastroenterol. 2011;47(2):212–216. doi:10.3109/00365521.2011.645502.
    1. Oey RC, DeMan RA, Erler NS, Verbon A, Buuren HR. Microbiology and antibiotic susceptibility patterns in spontaneous bacterial peritonitis:a study of two Dutch cohorts at a 10 years interval. United European Gastroenterol J. 2017;6(4):614–621. doi:10.1177/2050640617744456.
    1. Sajjad M, Khan ZA, Khan SM. Ascitic fluid culture in cirrhotic patients with spontaneous bacterial peritonitis. J Coll Physicians Surg Pak. 2016;26(8):658–661.
    1. Ariza X, Castellote J, Lora-Tamayo J, Girbau A, Salord S, Rota R, et al. Risk factors for resistance to ceftriaxone and its impact on mortality in community, healthcare and nosocomial spontaneous bacterial peritonitis. J Hepatol. 2012;56(4):825–832. doi:10.1016/j.jhep.2011.11.010.
    1. Kim J, Kang CI, Gwak GY, Chung DR, Peck KR, Song JH. Clinical impact of healthcare-associated acquisition in cirrhotic patients with community-onset spontaneous bacterial peritonitis. Korean J Intern Med. 2018 Mar 5; doi:10.3904/kjim.2017.231.
    1. Hung TH, Tsai CC, Hsieh YH, Tsai CC, Tseng CW, Tseng KC. The effect of the first spontaneous bacterial peritonitis event on the mortality of cirrhotic patients with ascites:A nationwide population-based study in Taiwan. Gut Liver. 2016;10(5):803–807. doi:10.5009/gnl13468.
    1. Fernandez J, Acevedo J, Castro M, Garcia O, de Lope CR, Roca D, et al. Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis:a prospective study. Hepatology. 2012;55:1551–1561. doi:10.1002/hep.25532.
    1. Piroth L, Pechinot A, Di Martino V, Hansmann Y, Putot A, Patry I, et al. Evolving epidemiology and antimicrobial resistance in spontaneous bacterial peritonitis:a two year observational study. BMC Infect Dis. 2014;14:287. doi:10.1186/1471-2334-14-287.

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