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Updated: Sep 28, 2026
Colon Ascendens Stent Peritonitis (CASP) - a Standardized Model for Polymicrobial Abdominal Sepsis
Published on: December 18, 2010
[Clinical and microbiological characteristics of spontaneous bacterial peritonitis (SBP) in a recent five year
Hee Gon Song1, Han Chu Lee, Yeon Ho Joo
1Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. hch@www.amc.seoul.kr
Background/Aims:
Recently, treatment failure with the third generation of cephalosporin was increasingly noted in patients with spontaneous bacterial peritonitis (SBP). We therefore were to evaluate the pattern of antibiotic resistance and its clinical significance.
Methods:
We retrospectively analyzed 580 episodes of SBP occurring between 1995 and 1999. There were 87 episodes of SBP in 1995, 222 in 1998, and 271 in 1999. The pattern of isolated organisms and antibiotic resistance, and prognostic factors for survival, were analyzed.
Results:
Microorganisms were isolated in 41% of total episodes. The three most frequently isolated organisms were E. coli (48%), K. pneumoniae (15%), and Aeromonas (8%). The percentage of resistant strains to cefotaxime (9%, 14%, 32%) and ciprofloxacin (13%, 21%, 32%) significantly increased. The proportion of E. coli producing extended spectrum beta-lactamase (ESBL) also increased significantly (0%, 16%, 33%). The need of secondary antibiotics such as imipenem due to treatment failure was significantly increased from 0% in 1995 to 33% in 1999. Overall in-hospital mortality, however, was not changed (20%, 20%, 24%, respectively). The factor affecting early mortality was renal failure at diagnosis. Prognostic factors for long-term survival were the presence of associated malignancy and ESBL-producing microorganisms.
Conclusion:
Microorgansims resistant to third generation cephalosporin and quinolone were increasingly isolated over the 5 years in patients with SBP. Measures to prevent in-hospital spread of resistant strains and indiscreet use of antibiotics should therefore be instituted.
Insights
Antibiotic resistance in spontaneous bacterial peritonitis (SBP) is rising, with increased resistance to cefotaxime and ciprofloxacin observed. This trend necessitates improved infection control and antibiotic stewardship to combat treatment failures.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Context:
- Spontaneous bacterial peritonitis (SBP) is a serious complication in patients with advanced liver disease.
- Treatment failure with third-generation cephalosporins in SBP has become increasingly common.
- Understanding evolving antibiotic resistance patterns is crucial for effective SBP management.
Purpose:
- To evaluate the changing patterns of antibiotic resistance in microorganisms causing SBP.
- To assess the clinical significance of increasing antibiotic resistance in SBP.
- To identify prognostic factors influencing survival in SBP patients.
Summary:
- A retrospective analysis of 580 SBP episodes (1995-1999) revealed a significant increase in resistance to cefotaxime and ciprofloxacin.
- Escherichia coli resistance, including extended-spectrum beta-lactamase (ESBL) production, rose substantially.
- While overall mortality remained stable, factors like renal failure, malignancy, and ESBL-producing organisms impacted survival.
Impact:
- The study highlights a growing challenge in treating SBP due to antimicrobial resistance.
- Findings underscore the urgent need for enhanced infection control measures and judicious antibiotic use.
- This research informs clinical practice and public health strategies for managing SBP in the era of rising resistance.
