Microbiology and resistance in first episodes of spontaneous bacterial peritonitis: implications for management and prognosis

Abstract

Third-generation cephalosporins have poor microbial coverage for treatment of SBP. Current guidelines need to adapt for the emerging number of Gram-positive infectious agents in SBP patients.

Spontán bakteriális peritonitis

“…Ilyenkor a várható kóroko-zók elsősorban GPB-k, legtöbbször a Streptococcus speciesek. Arányuk az elmúlt néhány évben fokozatosan nő, egyes tanulmányokban már meghaladta a GNB-két [24,25]. Nosocomialis infekciók esetén a GPB-k aránya 63% körül van [26].…”

Spontaneous Bacterial Peritonitis: Is It Still A Life-Threatening Issue in Cirrhosis?

“…The only drawback of this treatment is the recent observation of quinolone-resistant organism emergence [58] . The widespread use of quinolones to SBP's prophylaxis in highrisk subgroups of patients as well as frequent hospitalizations with invasive procedures associated with the exposure to broad-spectrum antibiotics have led to a change in intestinal flora with more grampositives and the occurrence of extended-spectrum b-lactamase producing Enterobacteriaceae in recent years [68][69][70] . Some risk factors have been identified as important factors for the emergence of multiresistant infections as nosocomial origin of infection, long-term norfloxacin prophylaxis, recent infection with multiresistant bacteria, and recent use of beta-lactam antibiotics.…”

“…Some risk factors have been identified as important factors for the emergence of multiresistant infections as nosocomial origin of infection, long-term norfloxacin prophylaxis, recent infection with multiresistant bacteria, and recent use of beta-lactam antibiotics. Infections with these resistant organisms are associated with a higher mortality rate [8,62,68,70] . Moreover, none of the international guidelines to date differentiate between nosocomial and community-acquired SBP with regard to the type of antibiotic regimen to be used and new guidelines are urgently needed.…”

“…Another important issue is the increasing incidence of extended-spectrum b-lactamase (ESBL)-producing bacteria as well as multiresistant Gram-positive bacteria (Enterococcus faecium) or methicillin-resistant Staphylococcus aureus(MRSA) in this setting. ESBLs cause resistance to various types of newer b-lactam antibiotics (third-generation cephalosporins, monobactams, quinolones, e.g) [45,69,70] . In-hospital mortality and/or 30-day mortality have been shown to be increased in nosocomial SBP caused by multiresistant bacteria compared with common bacteria [71,72] .…”

Letter: the emergence of multi‐drug resistant spontaneous bacterial peritonitis: a new challenge for the hepatologist? Authors' reply

“…6 Sol a et al suggest that third-generation cephalosporins continue to be the gold-standard treatment for community-acquired SBP. However, in cases of nosocomial SBP initial empirical antibiotic treatment should be piperacillin/tazobactam or meropenem AE glycopeptide antibiotic.…”