Session Title: Category 2b. CIRRHOSIS AND ITS COMPLICATIONS: b. CLINICAL ASPECTS
Presentation Date: Apr 15, 2010
ANTIBIOTIC-RESISTANT BACTERIA IN SPONTANEOUS BACTERIAL PERITONITIS. IS IT TIME TO CHANGE?
J. Castellote*, X. Ariza, A. Girbau, T. Broquetas, T. Lobatón, S. Salord, R. Rota, X. Xiol
Hepatology Section, IDIBELL, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain. *firstname.lastname@example.org
Background and aims: Third generation cephalosporins are considered first-line antibiotic therapy in patients with spontaneous bacterial peritonitis (SBP). However, antibiotic susceptibility of bacteria involved in SBP is changing in the last years. The aim of our study is to know in vitro susceptibility of isolated bacteria in SBP episodes in our centre.
Methods: We have reviewed all antibiograms of bacteria isolated in SBP episodes in the last 8 years. SBP was defined as a PMN count in ascitic fluid ≥ 250/µL in the absence of an intra-abdominal source of infection. Ascitic fluid culture was performed into blood culture bottles. Nosocomial SBP was defined when diagnosis was made after 72 hours of admission or when a previous PMN count during admission was < 250/µL.
Results: we studied 220 SBP episodes. Bacteria were isolated in 131 episodes (59,5%): 111 in ascitic fluid and 20 in blood cultures. They were nosocomial in 51 episodes (39%) and secondary to a gram-negative in 84 episodes (64%). In 75 % of cases, bacteria were susceptible to cefotaxime (61% in nosocomial episodes vs. 85% in community episodes, p< 0,001). Extended-spectrum beta-lactamases enterobacteriaceae was involved in 8 out of 31 cefotaxime resitant episodes and in other 8 cases resistance was secondary to enterococi. In 81% of episodes, bacteria were susceptible to amoxicillin/clavulanate (77% in gram-negative and 87% in gram-positive, p< 0,05). Susceptibility to ciprofloxacin was present in 62% of episodes. All except two bacteria were susceptible to carbapenems. Glicopeptids addition to cefotaxime represents a minor increase in susceptibility. Gram-negative susceptibility to cefotaxime and amoxicillin/clavulanate decrease from the first to the second period of study, from 81% to 74% and from 86% to 60%, respectively.
- A quarter of SBP episodes are secondary to bacteria resistant to cefotaxime.
- Carbapenems may be a useful alternative in those cases with risk factors to develop a cefotaxime-resistant episode.