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Colon Ascendens Stent Peritonitis (CASP) - a Standardized Model for Polymicrobial Abdominal Sepsis
Published on: December 18, 2010
Increasing frequency of gram-positive cocci and gram-negative multidrug-resistant bacteria in spontaneous bacterial
Alexandra Alexopoulou1, Nikolaos Papadopoulos, Dimitrios G Eliopoulos
12nd Department of Medicine, University of Athens Medical School, Athens, Greece. alexopou@ath.forthnet.gr
Background:
Spontaneous bacterial peritonitis (SBP) is historically caused by Gram-negative bacteria (GNB) almost exclusively Enterobacteriaceae. Recently, an increasing rate of infections with Gram-positive cocci (GPC) and multidrug-resistant (MDR) microorganisms was demonstrated.
Aims:
To assess possible recent changes of the bacteria causing SBP in cirrhotic patients.
Methods:
We retrospectively recorded 47 cases (66% males) during a 4-year-period (2008-2011).
Results:
Twenty-eight (60%) patients had healthcare-associated infections while 15 (32%) received prophylactic quinolone treatment. GPC were found to be the most frequent cause (55%). The most prevalent organisms in a descending order were Streptococcus spp (n = 10), Enterococcus spp (n = 9), Escherichia coli (n = 8), Klebsiella pneumonia (n = 5), methicillin-sensitive Staphylococcus aureus (n = 4) and coagulase-negative Staphylococcus spp (n = 3). Nine of the isolated bacteria (19%) were MDR, including carbapenemase-producing K. pneumonia (n = 4), followed by extended-spectrum beta-lactamase-producing E. coli (n = 3) and Pseudomonas aeruginosa (n = 2). MDR bacteria were more frequently isolated in healthcare-associated than in community-acquired infections (100% vs 50%, P = 0.006), in patients receiving long-term quinolone prophylaxis (67% vs 24%, P = 0.013) and in those with advanced liver disease as suggested by higher MELD score (28 vs 19, P = 0.012). More infections with GNB than GPC were healthcare-associated (81% vs 42%, P = 0.007). Third-generation cephalosporin resistance was observed in 49% and quinolone resistance in 47%.
Conclusions:
GPC were the most frequent bacteria in culture-positive SBP and a variety of drug-resistant microorganisms have emerged. As a result of high rates of resistance in currently recommended therapy and prophylaxis, the choice of optimal antibiotic therapy is vital in the individual patient.
Insights
Gram-positive cocci are now the most common cause of spontaneous bacterial peritonitis (SBP) in cirrhotic patients, with a rise in multidrug-resistant organisms. Optimal antibiotic selection is crucial due to increasing resistance rates.
Area of Science:
- Infectious Diseases
- Hepatology
- Microbiology
Background:
- Spontaneous bacterial peritonitis (SBP) traditionally stems from Gram-negative bacteria (GNB), primarily Enterobacteriaceae.
- Recent trends indicate a concerning increase in infections caused by Gram-positive cocci (GPC) and multidrug-resistant (MDR) organisms.
Purpose of the Study:
- To investigate recent shifts in bacterial pathogens responsible for SBP in patients with liver cirrhosis.
- To evaluate the prevalence of different bacterial species and their antimicrobial resistance patterns.
Main Methods:
- A retrospective analysis of 47 SBP cases in cirrhotic patients between 2008 and 2011.
- Data collection included patient demographics, infection source (healthcare-associated vs. community-acquired), and prior antibiotic prophylaxis.
Main Results:
- Gram-positive cocci (GPC) emerged as the predominant cause of SBP (55%), surpassing GNB.
- Multidrug-resistant (MDR) bacteria were identified in 19% of cases, including carbapenemase-producing Klebsiella pneumoniae and extended-spectrum beta-lactamase-producing Escherichia coli.
- Higher rates of MDR infections were associated with healthcare-associated infections, quinolone prophylaxis, and advanced liver disease (higher MELD score).
- Significant resistance rates were observed for third-generation cephalosporins (49%) and quinolones (47%).
Conclusions:
- Gram-positive cocci are now the leading bacterial cause of SBP in this cirrhotic patient cohort.
- The emergence of diverse drug-resistant microorganisms necessitates careful consideration of antibiotic therapy.
- High resistance rates underscore the critical importance of selecting appropriate empirical and targeted antibiotic treatments for SBP.
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