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

Fiore, Marco; Maraolo, Alberto Enrico; Gentile, Ivan; Borgia, Guglielmo; Leone, Sebastiano; Sansone, Pasquale; Passavanti, Maria Beatrice; Aurilio, Caterina; Pace, Maria Caterina

doi:10.3748/wjg.v23.i25.4654

Cited by 47 publications

(40 citation statements)

References 49 publications

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“…The rate of 25% MDR bacteria found in all bacterascites episodes was relatively high for the Netherlands, but it is in line with current international microbiologic SBP studies reporting MDR bacteria rates of 27%‐67% . The involvement of MDR bacteria in bacterascites was not associated independently with mortality in our study.…”

Section: Discussionsupporting

confidence: 90%

Bacterascites: A study of clinical features, microbiological findings, and clinical significance

Oey

Buuren

Jong

et al. 2018

Liver International

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BackgroundKnowledge about bacterascites is limited and management guidelines are based on small patient series. The purpose of this study was to add further insight into the clinical characteristics, microbiological findings, and prognosis of patients diagnosed with bacterascites.MethodsRetrospective analysis of patients with advanced chronic liver disease diagnosed with bacterascites and SBP between January 2003 and August 2016.ResultsIn this study, 123 patients were included with 142 episodes of bacterascites. The median MELD score was 20 and clinical symptoms of infection were present in 78%. Empiric antibiotic treatment was initiated in 68%. In 26 untreated patients undergoing repeated paracentesis, 42% were diagnosed with either ongoing bacterascites or SBP. The presence of signs or symptoms of infection was not an independent predictor for mortality or spontaneous resolution of infection. The 1‐month and 1‐year mortality rates of the 123 patients studied, were 32% and 60%, respectively; these results were in line with data pertaining to the prognosis of SBP.ConclusionsPatients with bacterascites and SBP are highly comparable with respect to severity of liver disease and overall prognosis. If left untreated, bacterascites is likely to persist or to evolve to SBP in a significant proportion of patients. The results of this study support current guidelines regarding the treatment of ascitic fluid infection, but could not confirm the prognostic relevance of symptomatic disease at the time of diagnosis. We suggest that the threshold to initiate antibiotic treatment, in particular in cases with severely advanced liver disease, should be low.

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Section: Discussionsupporting

confidence: 90%

Bacterascites: A study of clinical features, microbiological findings, and clinical significance

Oey

Buuren

Jong

et al. 2018

Liver International

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“… Infection management algorithm of spontaneous peritonitis due to Gram-positive bacteria[ 45 , 46 , 51 , 54 , 61 , 62 , 65 , 72 , 80 , 82 - 84 ]. AMP: Ampicillin; CFX: Cefotaxime; CFZ: Cefazolin; CPT: Ceftaroline; CTX: Ceftriaxone; DAP: Daptomycin; EAT: Empiric antibacterial therapy; GEN: Gentamicin; LNZ: Linezolid; MDR: Multidrug resistant; MER: Meropenem; MRSA: Methicillin-resistant S. aureus ; MSSA: Methicillin-susceptible S. aureus ; OXA: Oxacillin; PMN: Polymorphonuclear; TGC: Tigecycline; VAN: Vancomycin; VRE: Vancomycin-resistant enterococci.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, antibiotics administered within the past 30 d before SBP diagnosis and a lower sepsis-related organ failure assessment (commonly known as SOFA) score proved to be significantly associated with SBP by GPB in a cohort of 77 patients[ 79 ]. The impact of MDR-GPB on SBP patient mortality is not well investigated; recently, we performed a systematic review aimed at summarizing the evidence from the literature concerning the epidemiology of nosocomial cases of SBP, in order to highlight the importance of MDR bacteria outcome; of the initial 2556 manuscripts retrieved, only 9 were included in the qualitative analysis, and a quantitative analysis on mortality was not possible[ 80 ].…”

Section: Future Perspectivesmentioning

confidence: 99%

Current concepts and future strategies in the antimicrobial therapy of emerging Gram-positive spontaneous bacterial peritonitis

Fiore¹,

Maraolo²,

Gentile³

et al. 2017

WJH

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Spontaneous bacterial peritonitis (SBP) is the most common infection in end-stage liver disease patients. SBP is defined as an ascitic fluid infection with a polymorphonuclear leucocyte count ≥ 250/mm3 without an evident intra-abdominal surgically treatable source. Several mechanisms contribute to SBP occurrence, including translocation of gut bacteria and their products, reduced intestinal motility provoking bacterial overgrowth, alteration of the gut’s barrier function and local immune responses. Historically, Gram-negative enteric bacteria have been the main causative agents of SBP, thereby guiding the empirical therapeutic choice. However, over the last decade, a worryingly increasing prevalence of Gram-positive and multi-drug resistant (MDR) SBP has been seen. Recently, the microbiological spectrum of SBP seems to have changed in Europe due to a high prevalence of Gram-positive bacteria (48%-62%). The overall proportion of MDR bacteria is up to 22%-73% of cases. Consequently, empirical therapy based on third-generation cephalosporins or amoxicillin/clavulanic acid, can no longer be considered the standard of care, as these drugs are associated with poor outcomes. The aim of this review is to describe, with an epidemiological focus, the evidence behind this rise in Gram-positive and MDR SBP from 2000 to present, and illustrate potential targeted therapeutic strategies. An appropriate treatment protocol should include daptomycin plus ceftaroline and meropenem, with prompt stepdown to a narrower spectrum when cultures and sensitivity data are available in order to reduce both cost and potential antibiotic resistance development.

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“…Spontaneous peritonitis (SP) is an infection of ascites in cirrhotic patients without an alternative intra-abdominal focus of infection; when a cultural examination is performed on ascites, the growth of bacteria leads to a diagnosis of spontaneous bacterial peritonitis (SBP) and the growth of fungi leads to a diagnosis of spontaneous fungal peritonitis (SFP). 4 SP is the most common infection responsible for sepsis-induced acute-on-chronic liver failure. 5 Moreover, SP and urinary tract infections are the most common infections among decompensated end-stage liver disease (ESLD) patients.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous peritonitis in critically ill cirrhotic patients: a diagnostic algorithm for clinicians and future perspectives

Fiore

Maraolo

Leone

et al. 2017

TCRM

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Spontaneous peritonitis (SP) is the most common infection among decompensated end-stage liver disease patients. SP is the infection of ascitic fluid (neutrophil ascitic count ≥250/mL) without an alternative focus of abdominal infection. According to the causative agent, clinicians can make the diagnosis of spontaneous bacterial peritonitis or spontaneous fungal peritonitis. The mortality rate is very high, ranging from one-fifth of the patients with spontaneous bacterial peritonitis to four-fifths of the patients with spontaneous fungal peritonitis. An immediate and accurate diagnosis can improve the outcome in end-stage liver disease patients. The aim of this work is to provide physicians with a practical diagnostic guidance for SP diagnosis according to current evidence, in order to improve the management of cirrhotic patients with infected ascitic fluid.

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

Cited by 47 publications

References 49 publications

Bacterascites: A study of clinical features, microbiological findings, and clinical significance

Bacterascites: A study of clinical features, microbiological findings, and clinical significance

Current concepts and future strategies in the antimicrobial therapy of emerging Gram-positive spontaneous bacterial peritonitis

Spontaneous peritonitis in critically ill cirrhotic patients: a diagnostic algorithm for clinicians and future perspectives

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