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

Abstract

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.

An Epidemiological Meta-Analysis on the Worldwide Prevalence, Resistance, and Outcomes of Spontaneous Bacterial Peritonitis in Cirrhosis

“…This study also reports the overall prevalence of antibiotic resistance in SBP to be 11.51%, with MRSA having the highest prevalence of 6.23%, followed by ESBL (6.19%) and VRE (1.91%). The prevalence of antibiotic-resistant bacteria has been rising due to a global misuse of antibiotics (128), along with the increased frequency of hospitalization and need for invasive procedures in patients with cirrhosis (129). Additionally, rates of resistance varied by continent, which may be a product of varying national antibiotic regimens and policies (130).…”

Antimicrobial resistance in patients with decompensated liver cirrhosis and bacterial infections in a tertiary center in Northern Germany

“…Compared to other German centers, we found no VRE in ascites during SBP [ 35 , 41 ], despite high ratios of Enterococcus spp. , and could not detect an increase of MDR-bacteria [ 42 ]. However, parts of the gram-positive pathogens must be considered as possible contamination.…”

Pharmacokinetics and Pharmacodynamics of Fungal Defensin NZX Against Staphylococcus aureus-Induced Mouse Peritonitis Model

“…Although antibiotic therapy is a common strategy for eliminating bacterial infection, peritonitis caused by S. aureus remains a major complication of peritoneal dialysis with the characteristics of persistence and recurrence (Marciano et al, 2019 ; Alonso et al, 2021 ; Szeto et al, 2021 ). One of the major causes of recurrent peritonitis is from the emergence of antibacterial resistance during antibiotic treatment, especially from methicillin-resistant and multiple resistant strains (Li et al, 2020a ; Camargo et al, 2021 ). In addition, S. aureus can invade and replicate in various host cells, complicating the usage of antibiotics (Zhou et al, 2018 ; Wang et al, 2021 ); therapeutic effects were impeded by poor penetration or inferior intracellular stability.…”