Third-Generation Cephalosporin-Resistant Spontaneous Bacterial Peritonitis: A single-Centre Experience and Summary of Existing Studies

Chaulk, Jennifer; Carbonneau, Michelle; Qamar, Hina; Keough, Adam; Chang, Hsiu-Ju; Ma, Mang; Kumar, Deepali; Tandon, Puneeta

doi:10.1155/2014/429536

Cited by 38 publications

(36 citation statements)

References 23 publications

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“…At a liver unit in Spain, the prevalence doubled from <10% between 1998 and 2000 to 23% between 2010 and 2011 . In series across Europe, North America, and Asia, 11%‐45% of patients with SBP were infected with organisms resistant to first‐line third‐generation cephalosporins . Not surprisingly, these high rates of resistance have been associated with recent and frequent antibiotic use .…”

Section: Risks Of Antibiotic Prophylaxismentioning

confidence: 99%

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Antibiotic prophylaxis in cirrhosis: Good and bad

et al. 2016

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Patients with cirrhosis, particularly those with decompensated cirrhosis, are at increased risk of bacterial infections that may further precipitate other liver decompensations including acute‐on‐chronic liver failure. Infections constitute the main cause of death in patients with advanced cirrhosis, and strategies to prevent them are essential. The main current strategy is the use of prophylactic antibiotics targeted at specific subpopulations at high risk of infection: prior episode of spontaneous bacterial peritonitis, upper gastrointestinal bleeding, and low‐protein ascites with associated poor liver function. Antibiotic prophylaxis effectively prevents not only the development of bacterial infections in all these indications but also further decompensation (variceal bleeding, hepatorenal syndrome) and improves survival. However, antibiotic prophylaxis is also associated with a clinically relevant and increasing drawback, the development of infections due to multidrug‐resistant organisms. Several strategies have been suggested to balance the risks and benefits of antibiotic prophylaxis. Conclusion: Antibiotic stewardship principles such as the restriction of antibiotic prophylaxis to subpopulations at a very high risk for infection, the avoidance of antibiotic overuse, and early deescalation policies are key to achieve this balance; nonantibiotic prophylactic measures such as probiotics, prokinetics, bile acids, statins, and hematopoietic growth factors could also contribute to ameliorate the development and spread of multidrug‐resistant bacteria in cirrhosis. (Hepatology 2016;63:2019‐2031)

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Section: Risks Of Antibiotic Prophylaxismentioning

confidence: 99%

“…Infections due to MDR organisms are associated with an increased risk of septic shock, acute kidney injury, and death, in both the pretransplant and the posttransplant settings …”

Section: Risks Of Antibiotic Prophylaxismentioning

confidence: 99%

Antibiotic prophylaxis in cirrhosis: Good and bad

et al. 2016

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“…[3][4][5][6][7][8][9] These patients also have high risk for other complications such as spontaneous bacterial peritonitis (SBP), hyponatremia and hepatorenal syndromes, which increase the risk of fatal outcome. 1,3,[7][8][9][10][11][12][13][14][15][16] Several scores have been developed in order to predict severity of the disease and prognosis in order to consider liver transplantation as a potential treatment option. 2 These scores are Child Turcotte Pugh and MELD; however, they were designed for predicting liver transplantation requirements and mortality in the short term, but not while in hospital.…”

Section: Introductionmentioning

confidence: 99%

“…2 These scores are Child Turcotte Pugh and MELD; however, they were designed for predicting liver transplantation requirements and mortality in the short term, but not while in hospital. 3,[14][15][16][17][18][19][20][21] The present study was carried out in order to evaluate risk factors for in-hospital mortality in adult patients with ascites due to alcoholic cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

In-hospital mortality risk factors in patients with ascites due to cirrhosis

Vicco¹,

Rodeles²,

Ferini³

et al. 2015

Rev. Assoc. Med. Bras.

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Conflict of interest: noneIntroduction: ascites is one of the most common complications of cirrhosis associated with a high rate of mortality. Although several scores have been developed in order to assess the prognosis of the disease, they were designed for predicting liver transplantation requirements and mortality in the short term, but not while in hospital. The aim of this study was to weigh risk factors for in-hospital mortality in adult patients with ascites due to alcoholic cirrhosis. Material and methods: we performed a cross-sectional study in 180 adult patients with diagnosis of cirrhosis with portal hypertension associated with high alcohol intake. The diagnosis of cirrhosis was made by liver echography and portal hypertension was defined by clinical features plus serum-ascites albumin gradient. Sampled individuals were subjected to complete clinical examination. Child Pugh and the MELD scores were applied in all the patients. Results: nineteen patients died while in-hospital. Mortality was associated with increased levels of serum white blood cell, urea, creatinine, prolonged prothrombin time, aspartate aminotransferase and alanine aminotransferase. We conducted a multiple binary logistic to predict in-hospital mortality which yielded that serum urea, creatinine and prothrombin time made a significant contribution to prediction with an OR 14 (95% CI 12.8 -16.7 p = 0.03), 2 (95% CI 0.5 -3.47, p = 0.04), and 2 (95% CI 1.03 -2.31, p = 0.01) linearly-related. Conclusions: our results suggest that acute renal failure and prolonged prothrombin time are predictors of in-hospital mortality in patients with portal hypertension due to alcoholic cirrhosis.

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“…In light of recent increasing cephalosporin resistance (9) and CDI in LTRs (10) and our data demonstrating both, aggressive antibiotic allergy testing and delabeling should be evaluated (11). Use of cephalosporin and other broad-spectrum antibiotics is often a common target for antimicrobial stewardship programs; the addition of antibiotic allergy testing to high-risk antibiotic usage populations, such as transplant recipients, is likely to support antimicrobial stewardship programs by enhancing the use of first-line, narrow-spectrum agents (12).…”

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Antibiotic Allergy Labels in a Liver Transplant Recipient Study

Khumra

Chan

Urbancic

et al. 2017

Antimicrob Agents Chemother

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P atient-reported antibiotic allergies (so-called antibiotic allergy labels [AALs]) are associated with suboptimal prescribing and inferior clinical outcomes, especially in the immunocompromised (1, 2). The prevalence, type, and impact of AALs in liver transplant recipients (LTRs) remain ill defined. We report on AALs and their impact on a cohort of Australian LTRs.A retrospective matched-cohort study was conducted over a 5-year period (2010 to 2015) at an Australian liver transplant center (Austin Health). Using a departmental liver transplant database, LTRs with an AAL (AAL group) were identified. The same number of matched controls (LTRs without an antibiotic allergy label [non-AAL group]) were randomly selected for comparison. AALs were evaluated and classified as type A adverse drug reactions (ADRs; nonimmune mediated), type B ADRs (immune mediated), or of unknown type (3). Baseline demographics, transplant history, and infection-related admission data were collected. From the time of transplant until 12 months afterward, antibiotics administered during infection-related admissions and their duration of administration were recorded. Readmission, intensive-care unit (ICU) admission, Clostridium difficile infection (CDI), multidrug-resistant (MDR) organism isolation, and mortality rate were captured. An MDR organism was defined as a bacterium resistant to at least one agent in three or more antibiotic classes (4).Of 313 LTRs, 51 (16%) had Ն1 AAL. Females predominated in the AAL group (75% female versus 25% male; P ϭ 0.003), but there was no statistically significant differences in the rates of ICU admission and mortality between males and females (see Table S1 in the supplemental material). Seventy-seven AALs were recorded; of these, 23% (18/77) were type A ADRs, 66% were type B ADRs (51/77), and 10% (8/77) were of unknown type. Of the type A ADRs, 72% (13/18) were gastrointestinal upset, and of the type B ADRs, 6% (3/51) were severe cutaneous ADRs, 55% (28/51) were maculopapular exanthema, 35% (18/51) were anaphylaxis, urticaria, or angioedema, and 4% (2/51) were other reactions. The antibiotics implicated in AALs are demonstrated in Fig. 1

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Third-Generation Cephalosporin-Resistant Spontaneous Bacterial Peritonitis: A single-Centre Experience and Summary of Existing Studies

Abstract: Third-generation cephalosporin-resistant SBP is a common diagnosis and has an effect on clinical outcomes. In an attempt to reduce the mortality associated with resistance to empirical therapy, high-risk subgroups should receive broader empirical antibiotic coverage.

Cited by 38 publications

References 23 publications

Antibiotic prophylaxis in cirrhosis: Good and bad

Antibiotic prophylaxis in cirrhosis: Good and bad

In-hospital mortality risk factors in patients with ascites due to cirrhosis

Antibiotic Allergy Labels in a Liver Transplant Recipient Study

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