Session Title: Category 2b. CIRRHOSIS AND ITS COMPLICATIONS: b. CLINICAL ASPECTS
Presentation Date: Apr 15, 2010
RISK FACTORS TO CEFOTAXIME-RESITANT SPONTANEOUS BACTERIAL PERITONITIS
J. Castellote*, X. Ariza, A. Girbau, L. Rodriguez, X. Vazquez, S. Salord, C. Baliellas, X. Xiol
Hepatology Section, IDIBELL, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain. *email@example.com
Background and aims: Current practice guidelines recommend cefotaxime as initial empiric therapy in SBP episodes. Spontaneous bacterial peritonitis (SBP) secondary to cefotaxime-resistant bacteria increased in the last years and this fact implies an increase in mortality. The aim of our study is to find risk factors associated to SBP episodes secondary to cefotaxime-resistant bacteria.
Methods: We have reviewed 220 SBP episodes diagnosed in the last 8 years in a tertiary hospital. Bacteria were isolated in 131 episodes (59, 5%) and in 31 (23,6 %) episodes were cefotaxime-resistant. We have studied demographics, biochemical, microbiological and clinical data. We have performed a binary uni and multivariate regression analysis to determine those variables with independent statitistical value.
Results: Mean arterial pressure, ascetic fluid total protein and PMN count, previous UGB, the use of antibiotics for more than three days in the previous three months to SBP, norfloxacine prophylaxis, diabetes and nosocomial episodes were associated in the univariate analysis with bacteria cefotaxime-resistant. The multivariate analysis identified previous use of antibiotics in the three previous months (RR; 95%I.C.; p ) (5.98; 3.58-9.97; 0.000), diabetes (3.624; 2.08-6.30; 0.02) and nosocomial episodes (2.81; 1.75-4.51, 0.02 ) as independent risk factors. We have developed a simple score that can stratify the risk in three groups: low, intermediate and high risk with resistance rate of 7.7 %, 22 % y 57%, respectively.
- The use of antibiotics in the three previous months to SBP, diabetes and nosocomial episodes are independent risk factors to develop a cefotaxime-resistant SBP.
- The probability of cefotaxime-resistant SBP can be predicted by a simple score that combine these three variables.