Antibiotic resistance in healthcare‐related and nosocomial spontaneous bacterial peritonitis

Lutz, Philipp; Nischalke, Hans Dieter; Krämer, Benjamin; Goeser, Felix; Kaczmarek, Dominik J.; Schlabe, Stefan; Parčina, Marijo; Nattermann, Jacob; Hoerauf, Achim; Strassburg, Christian P.; Spengler, Ulrich

doi:10.1111/eci.12701

Cited by 51 publications

(69 citation statements)

References 33 publications

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“…18 In this trial, ESBL producers were the most common multidrug-resistant organisms (8.7%). 22 In some publications, nosocomial SBP correlated with significantly higher MDRO rates, 16,17,23,24 which is in line with our observations. Especially in nosocomial SBP patients, the percentage of Enterococcus faecium was 18.8%.…”

Section: Discussionsupporting

confidence: 91%

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Patients with cirrhosis and SBP: Increase in multidrug‐resistant organisms and complications

Zhang

Liss

et al. 2020

Eur J Clin Investigation

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Background: Spontaneous bacterial peritonitis (SBP) is a serious complication in patients with liver cirrhosis. In recent years, it has been postulated that the rate of multidrug-resistant organisms (MDROs) is increasing, especially in nosocomial SBP patients. Aim of the present work was to investigate this hypothesis and its possible clinical consequences. Materials and methods: One hundred and three culture-positive patients between 2007 and 2014 were compared with 81 patients between 2015 and 2017, to study the change of microbiological profiles and their clinical consequences. The cirrhosis patients with bacterascites requiring treatment were included as well. Results: The most prevalent Gram-negative bacteria isolated from ascites were Enterobacterales (31.6%) and in Gram-positive pathogens Staphylococci (22.8%).There was a significant increase in MDROs (22.3% ICU 40.7%, P = .048), accompanied by an increased incidence of sepsis (from 21.4% to 37.0%, P = .021), hepatorenal syndrome (from 40.8% to 58.0%, P = .007) and the need of catecholamine therapy (from 21.4% to 38.8%, P = .036). Nosocomial origin correlated with higher MDRO proportion, more complications and lower antimicrobial susceptibility rates in 12 commonly used antibiotics. MDROs were confirmed as an isolated predictor for inpatient mortality and complications in multivariable logistic regression. Conclusions: The feeling in clinical practice that MDROs have increased in the last 11 years could be confirmed in our study in Munich, Germany. Nosocomial SBP correlated with significantly higher MDRO rates (nearly 50%) and complication rates.In our opinion, an antibiotic combination with comprehensive effect should be taken into account in nosocomial SBP patients in this region. K E Y W O R D Santimicrobial susceptibility, liver cirrhosis, microbiological profile, multidrug-resistant organism, spontaneous bacterial peritonitis 2 of 8 | LI et aL.

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Section: Discussionsupporting

confidence: 91%

“…[5][6][7]16,[24][25][26] In this cohort, Gram-positive bacteria were twice as common as Gram-negative pathogens. [5][6][7]16,[24][25][26] In this cohort, Gram-positive bacteria were twice as common as Gram-negative pathogens.…”

Section: Discussionmentioning

confidence: 79%

Patients with cirrhosis and SBP: Increase in multidrug‐resistant organisms and complications

Zhang

Liss

et al. 2020

Eur J Clin Investigation

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“…Tables 1 and 2 describe the main features of included studies[12,20-27]. Eight of the 9 studies were conducted in University Hospitals.…”

Section: Resultsmentioning

confidence: 99%

“…Five hundred and twenty positive culture were nosocomial SP, of these 19 were fungal peritonitis and 501 were bacterial peritonitis, respectively. Identification of pathogens in ascitic fluids from patients with N-SBP is approximately 50%[12,27] as that reported historically in peritonitis not nosocomial[5]. The review shows that recently the bacterial spectrum seems to have changed with high prevalence of Gram-positive bacteria (29.3%-62.5%).…”

Section: Resultsmentioning

confidence: 99%

Nosocomial spontaneous bacterial peritonitis antibiotic treatment in the era of multi-drug resistance pathogens: A systematic review

Fiore

Maraolo

Gentile

et al. 2017

WJG

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AIMTo systematically review literature upon aetiology of nosocomial spontaneous bacterial peritonitis (N-SBP) given the rising importance of multidrug-resistant (MDR) bacteria.METHODSA literature search was performed on MEDLINE and Google Scholar databases from 2000 to 15th of November 2016, using the following search strategy: “spontaneous” AND “peritonitis”.RESULTSThe initial search through electronic databases retrieved 2556 records. After removing duplicates, 1958 records remained. One thousand seven hundred and thirty-five of them were excluded on the basis of the screening of titles and abstract, and the ensuing number of remaining articles was 223. Of these records, after careful evaluation, only 9 were included in the qualitative analysis. The overall proportion of MDR bacteria turned out to be from 22% to 73% of cases across the studies.CONCLUSIONN-SBP is caused, in a remarkable proportion, by MDR pathogens. This should prompt a careful re-assessment of guidelines addressing the treatment of this clinical entity.

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“…If patients are not responding to the empirically chosen antibiotic agent, bacterial resistance is likely, and the treatment must be tailored as soon as possible [1,57]. Fungal infections might also play a role once a nosocomial infection is not responding adequately [18,19,20], and antimycotic therapy should be considered accordingly (fig.…”

Section: Treatmentmentioning

confidence: 99%

Management of Infectious Complications Associated with Acute-on-Chronic Liver Failure

Engelmann

Berg

2018

Visc Med

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Introduction: Acute-on-chronic liver failure (ACLF) is associated with a high susceptibility to infections leading to complications and poor prognosis. The sensitized immune system overwhelmingly responds to invading bacteria leading to organ damage. After resolution of infection or prolonged disease duration, the phagocytic system becomes irresponsive with a reduced bacterial clearance capacity promoting secondary infection. Methods: This review focuses on the best management strategies for patients with ACLF and infections. Using the following terms, an extensive literature research on the Medline database was performed: ‘acute-on-chronic liver failure', ‘infection', ‘ACLF', ‘bacteria', ‘multi-resistance'. Results: Analysis of the literature confirmed that delayed diagnosis and treatment of infections in patients with ACLF results in a poor prognosis. Patients with ACLF should be considered as having a potential infection and should undergo a complete screening for sepsis. Once biochemical analysis indicates a potential infection, such as abnormal levels of C-reactive protein and procalcitonin, antibiotic treatment should be initiated immediately without microbiological culture results. For community-acquired infections third-generation cephalosporins are still the first choice, whereas in the nosocomial setting antibiotics with broader spectrum, such as piperacillin/combactam or carbapenems ± glycopeptides, are preferred. The patient should be re-assessed 48 h after treatment initiation in order to tailor the treatment. Non-response is suspicious, likely due to bacterial resistance or fungal infection, which should be considered when choosing further treatment strategies. Albumin substitution to prevent hepatorenal syndrome and to improve patients' outcome is mandatory in patients with spontaneous bacterial peritonitis. Prophylactic antibiotic therapy is suitable to prevent infections in high-risk patients. Conclusion: The screening for infections and its treatment is an essential part of managing patients with ACLF. In order to improve patients' prognosis, antibiotic treatment should be initiated once an infection is suspected. However, preventive strategies are already established and should be applied according to the guidelines.

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Antibiotic resistance in healthcare‐related and nosocomial spontaneous bacterial peritonitis

Abstract: Resistance to initial antibiotic treatment was associated with increased mortality. With resistance to cephalosporins being frequent, piperacillin-tazobactam or carbapenems might be preferred as treatment of SBP.

Cited by 51 publications

References 33 publications

Patients with cirrhosis and SBP: Increase in multidrug‐resistant organisms and complications

Patients with cirrhosis and SBP: Increase in multidrug‐resistant organisms and complications

Nosocomial spontaneous bacterial peritonitis antibiotic treatment in the era of multi-drug resistance pathogens: A systematic review

Management of Infectious Complications Associated with Acute-on-Chronic Liver Failure

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