Risk factors for resistance to ceftriaxone and its impact on mortality in community, healthcare and nosocomial spontaneous bacterial peritonitis

Factors Predicting Failure of 3rd Generation Cephalosporins in Treatment of Spontaneous Bacterial Peritonitis- A Retrospective Observational Study

“…Culture positivity (blood and ascitic fluid) was only 36 (21.4%). Culture positivity between 10%-40% been reported in various studies (12). Our low culture positivity may be due to earlier diagnosis of SBP, low bacterial population (1-2 bacteria/ml) in this population.…”

“…The effectiveness of cephalosporin has been questioned due to high prevalence of cefotaxim resistance in some part of the world due to frequent inadequate antibiotic exposure to these antibiotics by decompensate liver disease patients and frequent procedures in these patients. One retrospective study of two hundred and forty six episode of SBP revealed 3 rd generation cephalosporin resistance of 21.5% (7.1% in community acquired SBP, 21.1% in health care related SBP, 40.9% in nosocomially acquired SBP) (12) . For nosocomial SBP empirical antibiotic treatment with carbapenem and glycopeptide should be given.…”

The burden of extended-spectrum β-lactamase-producing Enterobacteriaceae in patients with cirrhosis

“…Recently, an increasing number of cases of SBP due to extended spectrum b-lactamase (ESBL)-producing E. coli, K. pneumonia have been reported in Asia [8][9][10][11] and Europe [12][13][14][15][16]. Some risk factors for SBP caused by ESBL-producing bacteria Enterobacteriaceae have been identified including the in-hospital acquisition of infection [10][11][12][13][14][15], long-term norfloxacin prophylaxis [13], use of blactams within the last 3 months [13], and infection by multiresistant bacteria in the last 6 months [13].…”

“…Some risk factors for SBP caused by ESBL-producing bacteria Enterobacteriaceae have been identified including the in-hospital acquisition of infection [10][11][12][13][14][15], long-term norfloxacin prophylaxis [13], use of blactams within the last 3 months [13], and infection by multiresistant bacteria in the last 6 months [13]. ESBLproducing strains are resistant not only to third-generation cephalosporins, amoxicillin-clavulanic acid but also to quinolones and trimethoprim-sulfamethoxazole [13].…”

“…In any case, these findings indicate that international recommendations stating that third-generation cephalosporins or amoxicillinclavulanic acid are the empiric antibiotics of choice for SBP [3] and are inappropriate for SBP episodes caused by ESBL-producing bacteria. Finally, studies have shown that SBP episodes due to ESBL-producing bacteria are more severe than episodes caused by strains sensitive to recommended empiric antibiotics [10][11][12][13][14]. The reasons for the severity of infections due to ESBL-producing bacteria are unknown; theoretically, poor prognosis may be related to a greater severity of the underlying liver disease, higher prevalence of septic shock, or delayed initiation of appropriate antibiotics.…”