Clinical Significance and Outcome of Nosocomial Acquisition of Spontaneous Bacterial Peritonitis in Patients with Liver Cirrhosis

Cheong, Hae Suk; Kang, Cheol-In; Lee, Jeong A; Moon, Soo Young; Joung, Mi Kyong; Chung, Doo Ryeon; Koh, Kwang Cheol; Lee, Nam Yong; Song, Jae-Hoon; Peck, Kyong Ran

doi:10.1086/597585

Cited by 158 publications

(224 citation statements)

References 13 publications

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“…Recent studies have reported an increasing prevalence of extended-spectrum β-lactamase-producing bacteria and multiresistant gram-positive bacteria such as Enteroccocus faecium or MRSA [52] . In fact, bacteria isolated in nosocomial SBP are frequently resistant to β-lactams (33%-78%), and this is associated with a low success rate in a significant proportion of nosocomial SBP [53][54][55][56] , which are being treated with third generation cephalosporins, amoxicillin/clavulanic acid or quinolones.…”

Section: Treatment Of Nosocomial Sbpmentioning

confidence: 99%

Diagnosis and management of bacterial infections in decompensated cirrhosis

Pleguezuelo

Benítez²,

Jurado³

et al. 2013

WJH

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Bacterial infections are one of the most frequent complications in cirrhosis and result in high mortality rates. Patients with cirrhosis have altered and impaired immunity, which favours bacterial translocation. Episodes of infections are more frequent in patients with decompensated cirrhosis than those with compensated liver disease. The most common and life-threatening infection in cirrhosis is spontaneous bacterial peritonitis followed by urinary tract infections, pneumonia, endocarditis and skin and soft-tissue infections. Patients with decompensated cirrhosis have increased risk of developing sepsis, multiple organ failure and death. Risk factors associated with the development of infections are severe liver failure, variceal bleeding, low ascitic protein level and prior episodes of spontaneous bacterial peritonitis (SBP). The prognosis of these patients is closely related to a prompt and accurate diagnosis. An appropriate treatment decreases the mortality rates. Preventive strategies are the mainstay of the management of these patients. Empirical antibiotics should be started immediately following the diagnosis of SBP and the first-line antibiotic treatment is third-generation cephalosporins. However, the efficacy of currently recommended empirical antibiotic therapy is very low in nosocomial infections including SBP, compared to community-acquired episodes. This may be associated with the emergence of infections caused by Enterococcus faecium and extended-spectrum β-lactamaseproducing Enterobacteriaceae, which are resistant to the first line antimicrobial agents used for treatment. The emergence of resistant bacteria, underlines the need to restrict the use of prophylactic antibiotics to patients with the greatest risk of infections. Nosocomial infections should be treated with wide spectrum antibiotics. Further studies of early diagnosis, prevention and treatment are needed to improve the outcomes in patients with decompensated cirrhosis.

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Section: Treatment Of Nosocomial Sbpmentioning

confidence: 99%

Diagnosis and management of bacterial infections in decompensated cirrhosis

Pleguezuelo

Benítez²,

Jurado³

et al. 2013

WJH

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“…Common Gram-negative bacteria such as Escherichia coli and other coliforms such as Klebsiella spp. have been reported to be causative agents in at least 50% of cases [6][7][8][9][10]. Other causative organisms reported have included pneumococci, streptococci and miscellaneous Gram-positive and other Gram-negative organisms [6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Characterisation of bacteria in ascites—reporting the potential of culture-independent, molecular analysis

Rogers

Russell

Preston

et al. 2010

Eur J Clin Microbiol Infect Dis

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Spontaneous bacterial peritonitis (SBP) is a severe complication of liver disease. A significant proportion of patients have culture-negative ascites, despite having similar signs, symptoms and mortality to those with SBP. Therefore, empirical antibiotic treatment for infection is often started without knowledge of the causative organisms. Here, we investigated the potential of molecular techniques to provide rapid and accurate characterisation of the bacteria present in ascitic fluid. Ascites samples were obtained from 29 cirrhotic patients undergoing clinically indicated therapeutic paracentesis. Bacterial content was determined by terminal restriction fragment length polymorphism (T-RFLP) analysis, quantitative polymerase chain reaction (PCR) and 16S ribosomal clone sequence analysis. Bacterial signal was detected in all samples, compared to three out of ten using standard methods. Bacterial loads ranged from 5.5 × 10 2 to 5.4 × 10 7 cfu/ml, with a mean value of 1.9 × 10 6 cfu/ml (standard deviation± 9.6 × 10 6 cfu/ml). In all but one instance, bacterial species identified by culture were also confirmed by molecular analyses. Preliminary data presented here suggests that culture-independent, molecular analyses could provide rapid characterisation of the bacterial content of ascites fluid, providing a basis for the investigation of SBP development and allowing early and targeted antibiotic intervention.

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“…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].…”

mentioning

confidence: 99%

“…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].…”

mentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

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