First-line treatment with cephalosporins in spontaneous bacterial peritonitis provides poor antibiotic coverage.

Abstract

OBJECTIVE:

Spontaneous bacterial peritonitis is a common infection in cirrhosis, associated with a high mortality. Third-generation cephalosporins are recommended as first-line treatment. The aim was to evaluate the epidemiology of microbiological ascitic fluid findings and antimicrobial resistance in Denmark.

MATERIAL AND METHODS:

All patients with cirrhosis and a positive ascitic fluid culture, at three university hospitals in the Copenhagen area during a 7-year period, were retrospectively evaluated. Patients with apparent secondary peritonitis were excluded from the study.

RESULTS:

One hundred and forty cases with 187 microbiological isolates were identified. The findings were: Gram-positive cocci, n = 86 (45.9%); Enterobacteriaceae, n = 59 (31.7%), with Escherichia coli identified in 31 cases; anaerobes, n = 14 (7.5%); yeast, n = 12 (6.4%); and cutaneous flora, n = 15 (8.0%). One case of Listeria monocytogenes was identified (0.5%). Overall antibiotic coverage was 57% for cephalosporins, 73% for piperacillin-tazobactam, and 72% for meropenem. Mortality rates in patients with isolates susceptible or resistant to the initial antibiotic treatment at 30 days follow-up were 35% and 55%, respectively (p = 0.017, Log-rank test).

CONCLUSION:

Almost half of the isolates were Gram-positive cocci, and as the overall antibiotic coverage with a cephalosporin was only 57%, and survival significantly dependent on whether the microbial etiology was susceptible to initial antibiotic treatment or not, a change of standard empiric antibiotic regime should be considered. Piperacillin-tazobactam could be a favorable choice.

• Authors: Srdan Novovic, Synne Semb, Henrik Olsen, Claus Moser, Jenny Dahl Knudsen, Christian Homann
• Journal: Scandinavian journal of gastroenterology (Scand J Gastroenterol) Vol. 47 Issue 2 Pg. 212-6 (Feb 2012) ISSN: 1502-7708 [Electronic] England
• PMID: 22191479 (Publication Type: Journal Article)

Chemical References

• Anti-Bacterial Agents
• Cephalosporins
• Thienamycins
• Piperacillin, Tazobactam Drug Combination
• Penicillanic Acid
• Meropenem
• Piperacillin

Topics

• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (therapeutic use)
• Ascitic Fluid (microbiology)
• Cephalosporins (therapeutic use)
• Denmark
• Drug Resistance, Bacterial
• Escherichia coli
• Escherichia coli Infections (complications)
• Female
• Gram-Positive Bacterial Infections (complications)
• Gram-Positive Cocci
• Humans
• Kaplan-Meier Estimate
• Liver Cirrhosis (complications)
• Male
• Meropenem
• Middle Aged
• Mycoses (complications)
• Penicillanic Acid (analogs & derivatives, therapeutic use)
• Peritonitis (drug therapy, microbiology)
• Piperacillin (therapeutic use)
• Piperacillin, Tazobactam Drug Combination
• Retrospective Studies
• Thienamycins (therapeutic use)