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AIM: To evaluate the epidemiology and outcomes of culture-positive spontaneous bacterial peritonitis(SBP) and spontaneous bacteremia(SB) in decompensated cirrhosis.METHODS: We prospectively collected clinical, laboratory characteristics, type of administered antibiotic, susceptibility and resistance of bacteria to antibiotics in one hundred thirty cases(68.5% males) with positive ascitic fluid and/or blood cultures during the period from January 1, 2012 to May 30, 2014. All patients with SBP had polymorphonuclear cell count in ascitic fluid > 250/mm3. In patients with SB a thorough study did not reveal any other cause of bacteremia. The patients were followed-up for a 30-d periodfollowing diagnosis of the infection. The final outcome of the patients was recorded in the end of follow-up and comparison among 3 groups of patients according to the pattern of drug resistance was performed.RESULTS: Gram-positive-cocci(GPC) were found in half of the cases. The most prevalent organisms in a descending order were Escherichia coli(33), Enterococcus spp(30), Streptococcus spp(25), Klebsiella pneumonia(16), S. aureus(8), Pseudomanas aeruginosa(5), other Gram-negative-bacteria(GNB)(11) and anaerobes(2). Overall, 20.8% of isolates were multidrug-resistant(MDR) and 10% extensively drugresistant(XDR). Health-care-associated(HCA) and/or nosocomial infections were present in 100% of MDR/XDR and in 65.5% of non-DR cases. Meropenem was the empirically prescribed antibiotic in HCA/nosocomial infections showing a drug-resistance rate of 30.7% while third generation cephalosporins of 43.8%. Meropenem was ineffective on both XDR bacteria and Enterococcus faecium(E. faecium). All but one XDR were susceptible to colistin while all GPC(including E. faecium) and the 86% of GNB to tigecycline. Overall 30-d mortality was 37.7%(69.2% for XDR and 34.2% for the rest of the patients)(log rank, P = 0.015). In multivariate analysis, factors adversely affecting outcome included XDR infection(HR = 2.263, 95%CI: 1.005-5.095, P = 0.049), creatinine(HR = 1.125, 95%CI: 1.024-1.236, P = 0.015) and INR(HR =1.553, 95%CI: 1.106-2.180, P = 0.011).CONCLUSION: XDR bacteria are an independent lifethreatening factor in SBP/SB. Strategies aiming at restricting antibiotic overuse and rapid identification of the responsible bacteria could help improve survival.
AIM: To evaluate the epidemiology and outcomes of culture-positive spontaneous bacterial peritonitis (SBP) and spontaneous bacteremia (SB) in decompensated cirrhosis. METHODS: We prospectively collected clinical, laboratory characteristics, type of administered antibiotic, susceptibility and resistance of bacteria to antibiotics in one hundred thirty cases (68.5% males) with positive ascitic fluid and / or blood cultures during the period from January 1, 2012 to May 30, 2014. All patients with SBP had polymorphonuclear cell count in ascitic fluid> 250 / mm3. In patients with SB a thorough study did not reveal any other cause of bacteremia. The patients were followed-up for a 30-d period following introduction of the infection. The final outcome of the patients was recorded in the end of follow-up and nearby among 3 groups of patients according to the pattern of drug resistance was performed .RESULTS: Gram-positive-cocci (GPC) were found in half of the cases. The most prevalent organisms in a de The order of the order was Escherichia coli (33) Enterococcus spp (30) Streptococcus spp (25) Klebsiella pneumonia (16) S. aureus (8) Pseudomanas aeruginosa (5) other Gram- negative bacteria Overall, 20.8% of isolates were multidrug-resistant (MDR) and 10% extensively drug resistant (XDR). Health-care-associated (HCA) and / or nosocomial infections were present in 100% of MDR / XDR and in 65.5% of non-DR cases. Meropenem was the empirically prescribed antibiotic in HCA / nosocomial infections showing a drug-resistance rate of 30.7% while third generation cephalosporins of 43.8%. Meropenem was ineffective on both XDR bacteria and Enterococcus faecium All but one XDR were susceptible to colistin while all GPC (including E. faecium) and the 86% of GNB to tigecycline. Overall 30-d mortality was 37.7% (69.2% for XDR and 34.2% for the rest of the patients (log rank, P = 0.015). In multivariate analysis, factors adversely affecting outcome included XDR infection (HR = 2.263, Creatinine (HR = 1.125, 95% CI: 1.024-1.236, P = 0.015) and INR (HR = 1.553, 95% CI: 1.106-2.180, P = 0.011) ) .CONCLUSION: XDR bacteria are an independent lifethreatening factor in SBP / SB. Strategies aiming at restricting antibiotic overuse and rapid identification of the responsible bacteria could help improve survival.