Extensively drug-resistant bacteria are an independent predictive factor of mortality in 130 patients with spontaneous bacterial peritonitis or spontaneous bacteremia

Alexopoulou, Alexandra; Vasilieva, Larisa; Agiasotelli, Danai; Siranidi, K.; Pouriki, Sophia; Tsiriga, Athanasia; Toutouza, Marina; Dourakis, Spyridon P.

doi:10.3748/wjg.v22.i15.4049

Cited by 54 publications

(61 citation statements)

References 28 publications

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“…GPC were the most frequent bacteria in culture-positive cases of SBP and a variety of drug-resistant microorganisms have emerged23. Extensively drug-resistant bacteria are an independent predictor of mortality in patients with SBP24.…”

Section: Discussionmentioning

confidence: 99%

Nosocomial and Community-Acquired Spontaneous Bacterial Peritonitis in patients with liver cirrhosis in China: Comparative Microbiology and Therapeutic Implications

Shi

Wei

et al. 2017

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Spontaneous bacterial peritonitis (SBP) is a common complication of liver cirrhosis. This study was performed to compare the microbiological characteristics of nosocomial and community-acquired episodes of bacterial peritonitis in China. Five hundred and seventy-five strains were isolated from the ascitic fluid of cirrhotic patients from the Beijing 302 Hospital from January 2014 to December 2014. The patients in the community-acquired SBP (n = 311) and the nosocomial SBP (n = 264) groups exhibited significant differences in clinical symptoms (P < 0.01). In both groups, most of the bacteria were Escherichia coli, Klebsiella pneumoniae, coagulase-negative staphylococcus and Enterococcus. There were more frequent gram-positive cocci (G+ C) in the nosocomial group (n = 170). Compared with the community-acquired group, the proportion of Enterococcus was significantly increased in the nosocomial group (9.0% vs. 16.6%, P < 0.05). The resistance rate of the main pathogenic bacteria to the recommended first-line drug in the guideline was very high. Community-acquired and nosocomial SBP groups exhibited differences in clinical symptoms and antibiotic susceptibility tests. Optimal treatments should be provided for these patients. We recommend that cefoperazone/sulbactam or piperacillin/tazobactam should be used for the empirical treatment of SBP.

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Section: Discussionmentioning

confidence: 99%

Nosocomial and Community-Acquired Spontaneous Bacterial Peritonitis in patients with liver cirrhosis in China: Comparative Microbiology and Therapeutic Implications

Shi

Wei

et al. 2017

Sci Rep

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“…Antibiotic resistance has been a serious sequala in SBP patients and may be seen in as high as 78% of these patients (7). Multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains have been described in 20% and 10% of SBP patients, respectively (12). This phenomenon further signifies the importance of identifying microbial causes of SBP.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study on Ascetic Fluid Biochemical Markers in Cirrhotic Children with and Without Spontaneous Bacterial Peritonitis: A Cross-Sectional Observation

et al. 2019

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Background: Cirrhotic ascites is frequently complicated with spontaneous bacterial peritonitis (SBP). Objectives: Here, we assessed the diagnostic validity of some inflammatory markers in children with SBP. Methods: This cross-sectional study was performed in the Pediatric Gastroenterology Ward of Namazi hospital of Shiraz. SBP was considered as ≥ 250 polymorphonuclear cell (PMN) /µL ascetic fluid (AF). Results: Out of 150 liver cirrhotic patients with ascites, 41 (27.3%) were diagnosed with SBP. Mean WBC count and PMN per µL of AF were significantly higher in SBP patients than non-SBP (P < 0.0001). The highest specificity for the diagnosis of SBP was recorded for AF smear test (100%). Positive AF smear and culture tests rendered the highest positive predictive values (PPV, 100% and 88.2% respectively). The highest negative predictive value (NPV) was related to AF leukocyte esterase test (94.2%). The highest area under the curve (AUC) for diagnosis of SBP belonged to WBC count (0.956), total cell count (0.817), and LDH concentration (0.814) of AF. A cut off value of 290 WBC per µL AF resulted in respective 95.1% and 88.1% sensitivity and specificity. Trespass of WBC count and lactate dehydrogenase (LDH) level of AF higher than cutoff values (290 cells/µL, and 175 (u/L), respectively) resulted in 82.9%, 92.7%, 81%, and 93.5% sensitivity, specificity, PPV and NPV, respectively. Conclusions: Total cell and WBC counts of AF strongly correlated with ascetic PMN count. Ascetic LDH, alone or in combination with WBC count of AF can be used as a potential surrogate for PMN counts in diagnosis of SBP.

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“…Alexopoulou ve ark. (19) spontan bakteriyel peritonitli veya spontan bakteriyemisi olan 130 dekompanse siroz hastasında yaptıkları prospektif çalışmada 30 günlük sağkalımın XDR bakteriler ile enfekte grupta, MDR ve ilaca dirençli olmayan 'non-drug resistant (non-DR)' gruptaki hastalara göre daha kötü olduğunu bildirmişlerdir. Bu çalışmada XDR bakteriler ile enfekte hastaların mortalite oranı %69,2 iken MDR ve non-DR grubun mortalite oranı %34,2 olarak bildirilmiştir.…”

Section: Discussionunclassified

The Effect of Extensively Drug-resistant Infections on Mortality in Surgical Intensive Care Patients

Şahintürk¹,

Özdemirkan²,

Kılıç³

et al. 2018

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ÖZ Amaç: Bu çalışmanın amacı cerrahi hasta kohortunda yoğun bakım kaynaklı çoklu ilaç dirençli 'extensively drug resistant' (XDR) bakteriyel enfeksiyonların sonuçlarının değerlendirilmesidir. Gereç ve Yöntem: Başkent Üniversitesi Hastanesi, Anesteziyoloji ve Cerrahi Yoğun Bakım Ünitesi'nde Ocak 2016-Aralık 2016 tarihleri arasında XDR bakteri izole edilen hastaların verileri retrospektif olarak incelendi. İlk 24 saat içinde cerrahi geçirmiş ve yoğun bakım kabulünden 48 saat sonra yoğun bakım kaynaklı enfeksiyon gelişen, 18 yaş üzeri erişkin hastalar çalışmaya dahil edildi. Bulgular: Çalışma süresince cerrahi yoğun bakım ünitesine kabul edilen 341 hastanın hepsi ilk 24 saat içinde cerrahi geçirmiş hastalar idi. Bu 341 hastanın 30'unda (%9) XDR bakteri izole edildi. Ortalama APACHE II skoru 18,5±5,3, ortalama beklenen mortalite hızı 35±17,1 olarak hesaplandı. Ortalama yoğun bakım yatış süresi 27,0±27,4 gün iken ortalama hastane yatış süresi 49,0±34,3 gün idi. Hastane içi mortalite hızının %57 (n=17) olduğu görüldü. Sonuç: Çalışmamızın sonucunda cerrahi yoğun bakım hastalarında XDR bakteriyel enfeksiyonlarının sık görüldüğünü (%9) ve mortalite oranlarının yoğun bakım kabulünde hesaplanan APACHE II skoru ile elde edilen beklenen mortalite oranlarına göre daha yüksek olduğu tespit edilmiştir (%57 vs. %35). Anahtar Kelimeler: Çoklu ilaç dirençli, cerrahi yoğun bakım, mortalite ABSTRACT Objective: The aim of the study was to assess the outcomes of intensive care unit acquired extensively drug-resistant (XDR) bacterial infections in a surgical patient cohort. Materials and Methods: The data of patients with XDR bacteria isolated at Başkent University Hospital, Anesthesia and Surgical Intensive Care Unit between January 2016 and December 2016 were reviewed retrospectively. Adult patients over 18 years of age who had undergone surgery within the first 24 hours and who developed intensive care unit infection 48 hours after admission to intensive care unit were included in the study. Results: All of the 341 patients who admitted to the surgical intensive care unit during the study period were underwent surgery within the first 24 hours. XDR bacterial infections were isolated in 30 out (9%) of these 341 patients. The mean APACHE II score was calculated as 18.5±5.3, and expected mean mortality rate of 35±17.1. The mean length of intensive care unit stay was 27.0±27.4 days, while the mean hospital stay was 49.0±34.3 days. The hospital mortality rate was found to be 57% (n=7). Conclusion: As a conclusion of our study, we found that XDR bacterial infections were common (9%) among intensive care surgical patients and their mortality rate was higher than their expected mortality rate according to their APACHE II scores calculated during intensive care unit admission (57% vs. 35%, respectively).

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Extensively drug-resistant bacteria are an independent predictive factor of mortality in 130 patients with spontaneous bacterial peritonitis or spontaneous bacteremia

Abstract: XDR bacteria are an independent life-threatening factor in SBP/SB. Strategies aiming at restricting antibiotic overuse and rapid identification of the responsible bacteria could help improve survival.

Cited by 54 publications

References 28 publications

Nosocomial and Community-Acquired Spontaneous Bacterial Peritonitis in patients with liver cirrhosis in China: Comparative Microbiology and Therapeutic Implications

Nosocomial and Community-Acquired Spontaneous Bacterial Peritonitis in patients with liver cirrhosis in China: Comparative Microbiology and Therapeutic Implications

A Comparative Study on Ascetic Fluid Biochemical Markers in Cirrhotic Children with and Without Spontaneous Bacterial Peritonitis: A Cross-Sectional Observation

The Effect of Extensively Drug-resistant Infections on Mortality in Surgical Intensive Care Patients

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