Recognition of Antibiotic Resistance in Spontaneous Bacterial Peritonitis Caused by Escherichia coli in Liver Cirrhotic Patients in Civil Hospital Karachi

Kirplani, Pooja D; Ochani, Rohan Kumar; Memon, Zahid Ali; Tahir, Syeda Anjala; Khalid, Imran; Seetlani, Naresh Kumar; Abbasi, Amanullah; Kumar, M Pavan; Ali, Piyar

doi:10.7759/cureus.5284

Cited by 4 publications

(2 citation statements)

References 23 publications

(24 reference statements)

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“…Lekshmi USA, Jyothy A, Mohan SA, Mohammed AA, Arya MS, Merlin NJ and Dharan SS: A comparative retrospective and prospective analysis of emerging resistance in empirical antibiotic treatment among liver cirrhosis patients with spontaneous bacterial peritonitis: an interventional study in a Tertiary Care Hospital. Int J Pharm Sci & Res 2023; 14(3): 1352-64. doi: 10.13040/IJPSR.0975-8232.14 (3).1352-64.…”

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confidence: 99%

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2023

IJPSR

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Background: Previous hospitalization, nosocomial infection and specific risk factors like prolonged quinolone use for Spontaneous Bacterial Peritonitis prophylaxis can be related to drug-resistant bacterial infections and high mortality in liver cirrhosis. Aim and Objectives: To study the prescription pattern of antibiotics used in SBP, compare the efficacy and emerging resistance of antibiotics, and classify patients with different types of ascites. Methodology: The study was conducted in liver cirrhosis patients with SBP retrospectively (2 years) and prospectively (6 months) by a convenient sampling technique. The study was carried out in NIMS Medicity, Thiruvananthapuram. Relevant data were collected via pre-approved data collection form and were subjected to SPSS statistics 22 and R software 4.1.1. analysis. Results: In our study, a total of 116 patients in the retrospective and 21 patients in the prospective study were obtained. 26 patients (22.4%) from the retrospective study and 4 patients (19%) among the prospective study had culture-positive ascitic fluid culture. E. coli was the most commonly obtained organism (69.24%). Third-generation cephalosporins showed higher resistance in the study (51.72%). Interpretation And Conclusion: This study's findings helped to figure out emerging antibiotic resistance in TGCs among Community-Acquired SBP. Strict adherence to the EASL guidelines for a second-time diagnostic paracentesis after 48 hours of empirical antibiotic therapy initiation (intervention of this study) could be continued as a powerful tool in identifying the accurate efficiency and response to the empirical antibiotic therapy used.

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confidence: 99%

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2023

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“…Nevertheless, there is concern about the risk of an increased frequency of more resistant bacteria in hospitalized patients with the use of broad-spectrum antibiotics as first-line treatment [ 22 ]. In fact, administration of inappropriate therapy can be associated with increased mortality [ 23 ].…”

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confidence: 99%

Spontaneous Bacterial Peritonitis in Cirrhotic Patients: A Shift in the Microbial Pattern? A Retrospective Analysis

Pimentel

Leitão

Gregório

et al. 2021

GE Port J Gastroenterol

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Introduction: Over the last decade, a shift in the spontaneous bacterial peritonitis (SBP) microbial pattern toward an increasing incidence of gram-positive and multidrug-resistant (MDR) bacteria has been reported. Systematic surveillance of the local microbiological scenario and antibiotic resistance is crucial to SBP treatment success. The main objective of this study was to evaluate the microbiological profile and bacterial resistance of SBP pathogens in a Portuguese cohort to allow selection of the most appropriate empirical antibiotics. Methods: This is a single-center retrospective study including 63 adult cirrhotic patients with culture-positive SBP. Patients were identified using a hospital general diagnostic database and searching for all SBP events (neutrophil count in ascitic fluid ≥250/mm3) from January 1, 2012, to December 31, 2017. Patients were excluded if they had culture-negative SBP, secondary peritonitis, peritoneal dialysis, a liver transplant, or immunodeficiency. The site of SBP acquisition was classified as nosocomial if it was diagnosed 48 h or longer after hospitalization or as nonnosocomial if it was diagnosed within the first 48 h. MDR bacteria were those with an acquired resistance to at least 1 agent in 3 or more antimicrobial categories. All statistical analyses were carried out using IBM SPSS Statistics software version 22 (IBM, New York, USA). Results: The study cohort comprised 53 (84.1%) men. The mean age of the patients was 60.6 ± 11.2 years. Alcohol was the most common etiology (88.9%) and most patients had advanced liver cirrhosis (87.1%, Child C). Gram-negative bacteria were slightly more frequent than gram-positive bacteria (56.9 vs. 43.1%). Escherichia coli was the most common pathogen (33.8%). Nineteen (31.7%) bacteria were classified as MDR. Resistance to third-generation cephalosporins, quinolones, piperacillin-tazobactam, and carbapenems was found in 31.7, 35, 26.7, and 18.3% of the cases, respectively. The rates of gram-positive bacteria were similar between nosocomial and nonnosocomial episodes (45 vs. 42.2%; p = 0.835). MDR bacteria were more common in the nosocomial group (50 vs. 23.8%; p = 0.046). Resistance to third-generation cephalosporins (50 vs. 23.8%; p = 0.046), piperacillin-tazobactam (44.4 vs. 19.1%; p = 0.041), and carbapenems (33.3 vs. 11.9%; p = 0.049) occurred more frequently in nosocomial episodes. Resistance to first-line antibiotic occurred in 29.3% of the patients, being more common in the nosocomial group (44.4 vs. 22.5%; p = 0.089). Conclusion: Although gram-negative bacteria remain the most common causative microorganisms, our results emphasize the shift in SBP microbiological etiology, as almost half of the isolated microorganisms were gram positive. The emergence of bacteria resistant to traditionally recommended empirical antibiotics underlines the importance of basing this choice on local flora and antibiotic susceptibility data, allowing a more rational and successful use of antibiotics.

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Clinical and Bacteriological features of spontaneous bacterial peritonitis in Malagasy patients with Cirrhosis

Rakotozafindrabe¹,

Razafindrazoto²,

Rasolonjatovo³

et al. 2021

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Background: Spontaneous bacterial peritonitis (SBP) represent frequent and serious complications in cirrhosis patients with ascites. Our aim was to describe the clinical and bacteriological characteristics of SBP in Madagascar.Methods: This is a 21-month prospective study between January 2018 and October 2019, including hospitalized patients with cirrhosis, with clinical and biological symptoms of SBP.Results: Thirty-three patients were included. The mean age was 48.09 ± 13.55 years (extremes: 19 – 78 years), the sex ratio was 3.12. Abdominal pain (55%), fever (36%), diarrhea (6%), hepatic encephalopathy (18%) are the most common symptoms. Gastrointestinal bleeding (18.18%) was the main risk factor to SBP. SBP was community-acquired in 87.88% of cases. A culture of ascites fluid was positive for 9 patients (27.27%). The infectious agents found were Escherichia coli (12.10%), Klebsiella pneumoniae (3%), Pseudomonas (3%), Streptococcus mitis (9.1%). Escherichia coli were wild with one case resistant to Ceftriaxone. The Klebsiella were multidrug resistant. The other two pathogens did not show resistance. After antibiotic therapy adapted to the antibiogram, healing was observed in 26 patients (78.78%). Seven patients (21.22%) died from various complications. All deceased patients had bacteria identified in ascites fluid.Conclusion: SBP defined according to clinical and biological criteria is apparently sterile in the majority of cases. Gram-negative bacteria were the major pathogens involved in SBP in cirrhotic patients. Escherichia coli and streptococcus were the most common pathogen isolated. Bacteriological study is essential to adapt antimicrobial to multidrug-resistant bacteria.

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Recognition of Antibiotic Resistance in Spontaneous Bacterial Peritonitis Caused by Escherichia coli in Liver Cirrhotic Patients in Civil Hospital Karachi

Cited by 4 publications

References 23 publications

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Spontaneous Bacterial Peritonitis in Cirrhotic Patients: A Shift in the Microbial Pattern? A Retrospective Analysis

Clinical and Bacteriological features of spontaneous bacterial peritonitis in Malagasy patients with Cirrhosis

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