Empirical Treatment With Carbapenem vs Third-generation Cephalosporin for Treatment of Spontaneous Bacterial Peritonitis

Kim, Sun Woong; Yoon, Jae Sung; Park, Junyong; Jung, Yong Jin; Lee, Jae Seung; Song, Jin Su; Lee, Yong Sang; Seo, Yeon Seok; Lee, Minjong; Park, Jin Myung; Choi, Dong‐Young; Kim, Moon Young; Kang, Seong Hee; Yang, Jin Mo; Song, Do Seon; Chung, Siu-Wah; Kim, Minseok Albert; Jang, Heejoon; Oh, Hyung-Geun; Lee, Cheol Hyung; Lee, Yun Bin; Cho, Eun Ju; Yu, Su Jong; Kim, Yoon Jun; Yoon, Jung Hwan; Lee, Jeong Hoon

doi:10.1016/j.cgh.2020.06.046

Cited by 16 publications

(19 citation statements)

References 38 publications

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“…Currently, they are recommended as the first-line antibiotics (e.g., IV cefotaxime 2 g every 12 hours) in settings where MDROs are not prevalent (Table 7). With a growing number of infections by MDROs (172,183), cephalosporins have become less effective, and initial antibiotic therapy should be broader in those with a high likelihood of harboring MDRO infections, specifically those with nosocomial infection or recent hospitalization and critically ill patients admitted in the intensive care unit (183,184). Inappropriate initial antimicrobial therapy in patients admitted with septic shock increases the risk of death by 10 times (175).…”

Section: Management Of Sbpmentioning

confidence: 99%

“…Inappropriate initial antimicrobial therapy in patients admitted with septic shock increases the risk of death by 10 times (175). Initial use of carbapenems may lead to higher resolution of SBP and lower mortality in patients with nosocomial (185) or critically ill patients (184). Given increasing recent failure rates of initial antibiotic therapy, which may lead to increased mortality (186,187), it is recommended that a diagnostic paracentesis (or thoracentesis for SBE) be performed 48 hours after initiating antibiotic therapy to assess response.…”

Section: Management Of Sbpmentioning

confidence: 99%

“…(175) Initial use of carbapenems may lead to higher resolution of SBP and lower mortality in patients with nosocomial (185) or critically ill patients. (184) The emerging threat of MDROs highlights the importance of antibiotic stewardship-antibiotic coverage should be narrowed as soon as culture results are available and given for as short a time as possible. Additionally, the type of broad-spectrum antibiotics should be tailored to local prevalence and type of MDRO.…”

Section: Management Of Sbp Antibioticsmentioning

confidence: 99%

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Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases

et al. 2021

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This is a comprehensive guidance on the diagnosis, evaluation, and management of ascites and hepatorenal syndrome in patients with chronic liver disease from the American Association for the Study of Liver Diseases (AASLD). It replaces the prior AASLD guideline on the same topic published in 2012 (1).This AASLD Guidance provides a data-supported approach to the management of ascites and hepatorenal syndrome. It differs from AASLD Guidelines, which are supported by systematic reviews of the literature, formal rating of the quality of the evidence and strength of the recommendations. In contrast, this Guidance was developed by consensus of an expert panel and provides guidance statements based on comprehensive review and analysis of the literature on the topics, with oversight provided by the AASLD Practice Guidelines Committee. The AASLD Practice Guidelines Committee chose to perform a Guidance on this topic because a sufficient number of randomized controlled trials were not available to support meaningful systematic reviews and meta-analyses. A. Introduction Burden of Cirrhotic Ascites and Hepatorenal SyndromeHepatic decompensation, defined by ascites, hepatic encephalopathy, and portal hypertensive gastrointestinal bleeding, is an important landmark in the natural history of cirrhosis (2). Ascites is commonly the first decompensation-defining event, with 5%-10% of patients with compensated cirrhosis developing ascites per year (3). The development of ascites is associated with a reduction in 5-year survival from 80% to 30% (4), which is due in part to patients with ascites being prone to additional complications such as bacterial infections, electrolyte abnormalities, hepatorenal syndrome (HRS) and nutritional imbalances, and consequently, further clinical decline (5). Patients with cirrhosis who develop clinically significant ascites and related complications should be considered for referral for liver transplantation (LT) evaluation and, where appropriate, palliative care (6).HRS is a late complication of cirrhosis that accounted for 3.2% of all hospital discharges related to cirrhosis according to a 2012 study based on a large inpatient health care database of patients representative of community hospitals in the United States (4). Moreover, the number of HRS discharges in the United States has increased significantly in the past 2 decades (7). HRS was also associated with high inpatient mortality (~46%), as well as longer lengths of stay and higher costs of hospitalizations, compared to cirrhosis discharges without HRS.

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Section: Management Of Sbpmentioning

confidence: 99%

Section: Management Of Sbpmentioning

confidence: 99%

Section: Management Of Sbp Antibioticsmentioning

confidence: 99%

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Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases

et al. 2021

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“…When considering nosocomial SBP, spontaneous bacterial empyema and spontaneous bloodstream infections, the use of piperacillin/tazobactam or carbapenems, with or without lypopeptides/glycopeptides should be considered [ 35 , 36 ]. The empirical use of carbapenems should be used only in centers with a high rate of MDR bacteria or in patients with organ failures [ 37 ], because it carries on the risk of further emergence of XDR bacteria. Nosocomial pneumonia should be treated with piperacillin/tazobactam or carbapenems plus a respiratory quinolone active against Pseudomonas .…”

Section: Management Of Bacterial Infectionsmentioning

confidence: 99%

“…In patients at high risk of mortality such as those with sepsis, ACLF or septic shock patients should be aggressively treated with antibiotic schemes provided for nosocomial infections ( Fig. 3 ) [ 37 ]. Indeed, in these patients, antibiotic treatment should not fail, because failure is associated with a surge in the risk of death.…”

Section: Management Of Bacterial Infectionsmentioning

confidence: 99%

Changes in the epidemiology and management of bacterial infections in cirrhosis

2021

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Patients with cirrhosis are susceptible to develop infections because of immune dysfunction, changes in microbiome and increase in bacterial translocation from the gut to systemic circulation. Bacterial infections can worse the clinical course of the disease, triggering the development of complications such as acute kidney injury, hepatic encephalopathy, organ failures and acute on chronic liver failure. In recent years, the spread of multi drug resistant bacteria made more challenging the management of infections in patients with cirrhosis. Hence, the mortality rate associated to sepsis is increasing in these patients. Therefore, the optimization of the management of infections has a high priority in cirrhosis. Herein we reviewed the recent changes in the epidemiology and the management of bacterial infections in patients with liver cirrhosis.

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Spontaneous Bacterial Peritonitis: The Bug Matters

Sandhu

John

2023

Dig Dis Sci

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Empirical Treatment With Carbapenem vs Third-generation Cephalosporin for Treatment of Spontaneous Bacterial Peritonitis

Cited by 16 publications

References 38 publications

Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases

Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases

Changes in the epidemiology and management of bacterial infections in cirrhosis

Spontaneous Bacterial Peritonitis: The Bug Matters

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