Patterns of Antimicrobial Resistance in the Causative Organisms of Spontaneous Bacterial Peritonitis: A Single Centre, Six-Year Experience of 1981 Samples

Abstract

Background/Aims. Spontaneous bacterial peritonitis (SBP) is one of the leading causes of morbidity and mortality in patients with cirrhosis. This study aims to determine the microbial agents of SBP and the pattern of antibiotic resistance, in a large number of ascitic samples. Methodology. In a cross-sectional, single center, hospital based study, 1981 consecutive ascitic fluid samples were recruited from 2005 to 2011. Samples were dichotomized into three-year periods, in order to assess the trend of resistance to the first-line empirical antibiotics. Results. SBP was found in 482 (24.33%) of samples, of which 314 (65.15%) were culture positive. The most prevalent isolated pathogen was E. coli (33.8%), followed by staphylococcus aureus (8.9%) and Enterococcus (8.6%). No significant changes in the proportion of gram-negative/gram-positive infections occurred during this period. A percentage of resistant strains to cefotaxime (62.5%, 85.7%), ceftazidim (73%, 82.1%), ciprofloxacin (30, 59.8%), ofloxacin (36.8%, 50%), and oxacilin (35%, 51.6%) were significantly increased. E. coli was most sensitive to imipenem, piperacillin-tazobactam, amikacin, ceftizoxime, and gentamicin. Conclusions. The microbial aetiology of SBP remains relatively constant. However, the resistance rate especially to the first-line recommended antibiotics was significantly increased. This pattern must be watched closely and taken into account in empirical antibiotic treatment.

Expression of toll-like receptors in hepatic cirrhosis and hepatocellular carcinoma

“…It is noteworthy that E. coli, the most common pathogenic bacterium, can frequently cause spontaneous bacterial peritonitis (SBP) in cirrhosis. For example, Sheikhbahaei et al (2014) reported that 24.33% of the samples they studied were diagnosed with SBP, from which 65.15% were culture-positive. The most prevalent isolated pathogen was E. coli (33.8%), followed by Staphylococcus aureus (8.9%) and Enterococcus (8.6%).…”

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“…3 Spontaneous bacterial peritonitis is one of the leading causes of mortality and morbidity. 4 All patients with cirrhosis and ascites are at risk of developing SBP. One-year mortality after first diagnosis of SBP is shown to be between 31% and 93%.…”

“…1,5 Spontaneous bacterial peritonitis is a monomicrobial infection of ascites, which may occur by infection, translocation, or hematogenous dissemination of intestinal flora. 4 Bacterial trans location is the major mechanism of SBP. 3 Moreover, excess bacterial production in the intestine triggers translocation.…”

“…3 Moreover, excess bacterial production in the intestine triggers translocation. 4 The frequency of ascites development in patients with compensated cirrhosis in a 5-year span is about 30%. Prognosis of patients with cirrhosis significantly worsens after ascites development.…”

“…Mortality of patients treated in a hospital setting with cefotaxime was found to be 29%, a consistent rate in many other studies. [4][5][6] However, for patients treated in the hospital setting with both cefotaxime and albumin, the mortality decreased to 10%. Albumin may decrease the risk of hepatorenal syndrome development, a serious complication, 6 by increasing the effective circulating blood volume.…”