Impact of Microbiological Changes on Spontaneous Bacterial Peritonitis in Three Different Periods Over 17 Years

Abstract

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.

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

“…In the past decade, prevalence of MDR bacterial infections has increased substantially, what is consistent among serial studies from different geographical regions [2–8, 19]. In SBP infections, for instance, Fernández et al (Spain, 2012) [3], Oliveira et al (Portugal, 2016) [4], Costabeber et al (Brazil, 2016) [5], Oey et al (Netherlands, 2017) [7], and Sofjan et al (USA, 2018) [18] have reported MDR prevalence of 22, 20, 37, 32, and 30%, respectively.…”

“…SBP usually settles in a set of end-stage liver disease, and culture-positive SBP usually presents in patients with a more severe background and carries a poorer prognosis than culture-negative neutrocytic ascites [17], which may have resulted in a selection bias and explain the more severe stage of our patients if compared to other publications. On the other hand, we analyzed a similar or even bigger number of patients than previous reports with similar methodology focused in SBP [2, 7, 8, 18] and performed a comprehensive assessment of microbiological data on ascitic fluid infections.…”

“…We also showed a difference between gram-positive and gram-negative prevalence in ascitic infections, which may be related to reporting issues, once we analyzed and showed separate result for patients with SBP and bacterascites. Even though there is a growing incidence of gram-positive infections in cirrhotic patients [7, 8], true SBP seems to still be related to gram-negative bacteria.…”

“…Bacterial infection is one of the most important causes of acute decompensation and death in cirrhosis [1]. Recently, a growing body of research has described an increase in bacterial resistance in both general (e.g., pneumoniae) and specific (i.e., spontaneous bacterial peritonitis: SBP) infections in cirrhotic patients [2–8]. A number of traditional (e.g., previous hospitalization, nosocomial infection) and specific risk factors (e.g., quinolone use for SBP prophylaxis) have been related to drug-resistant bacterial infections in cirrhosis [2, 3].…”

Evaluation of Ascitic Fluid Neutrophil Gelatinase Associated Lipocalin in patients with Spontaneous Bacterial Peritonitis

“…Gram-positive germs are found in 25% of SBP episodes, with streptococcal species isolated the most commonly [7]. SBP patients may have one or more of the following symptoms: Peritonitis symptoms and signs include abdominal pain, tenderness, vomiting, diarrhoea, and ileus.…”