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Antibiotic resistance in healthcare‐related and nosocomial spontaneous bacterial peritonitis
Author(s) -
Lutz Philipp,
Nischalke Hans Dieter,
Krämer Benjamin,
Goeser Felix,
Kaczmarek Dominik J.,
Schlabe Stefan,
Parcina Marijo,
Nattermann Jacob,
Hoerauf Achim,
Strassburg Christian P.,
Spengler Ulrich
Publication year - 2017
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12701
Subject(s) - medicine , spontaneous bacterial peritonitis , antibiotic resistance , meropenem , ceftriaxone , antibiotics , enterococcus faecium , ciprofloxacin , piperacillin , enterococcus , cephalosporin , microbiology and biotechnology , cirrhosis , bacteria , pseudomonas aeruginosa , biology , genetics
Background Spontaneous bacterial peritonitis ( SBP ) can be life threatening in patients with liver cirrhosis. In contrast to community‐acquired SBP , no standard treatment has been established for healthcare‐related and nosocomial SBP . Materials and methods We prospectively collected healthcare‐related and nosocomial SBP cases from March 2012 till February 2016 at the Department of Internal Medicine I of the University of Bonn and analysed the prevalence of antibiotic resistance among the isolated bacteria. SBP was diagnosed according to international guidelines. Ciprofloxacin, ceftriaxone and meropenem were used as reference substance for resistance to quinolones, third‐generation cephalosporins and carbapenems, respectively. Results Ninety‐two SBP episodes in 86 patients were identified: 63 episodes (69%) were nosocomial. Escherichia coli , Klebsiella species, enterococci and streptococci were most frequently isolated. Frequencies of these microorganisms were comparable for healthcare‐related and nosocomial SBP (14% vs. 11%, 14% vs. 8%, 14% vs. 5% and 10% vs. 6%, respectively). In general, antibiotic resistance was higher in isolates from nosocomial than from healthcare‐related SBP (50% vs. 18% for quinolones, 30% vs. 11% for piperacillin–tazobactam; P > 0·05), but comparable concerning third‐generation cephalosporins (30% vs. 33%). All microorganisms were sensitive to carbapenems apart from nosocomial infections with Enterococcus faecium ( n = 3) and Candida albicans ( n = 1) due to intrinsic resistance or lack of microbiological efficacy, respectively. No multidrug‐resistant microorganisms were detected. Resistance to initial antibiotic treatment affected 30‐day survival negatively (18% vs. 68%; P = 0·002). Conclusion Resistance to initial antibiotic treatment was associated with increased mortality. With resistance to cephalosporins being frequent, piperacillin–tazobactam or carbapenems might be preferred as treatment of SBP .