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Published on: December 18, 2010
Third-generation cephalosporin-resistant spontaneous bacterial peritonitis: a single-centre experience and summary of
Background:
Spontaneous bacterial peritonitis (SBP) is the most prevalent bacterial infection in patients with cirrhosis. Although studies from Europe have reported significant rates of resistance to third-generation cephalosporins, there are limited SBP-specific data from centres in North America.
Objective:
To evaluate the prevalence of, predictors for and clinical impact of third-generation cephalosporin-resistant SBP at a Canadian tertiary care centre, and to summarize the data in the context of the existing literature.
Methods:
SBP patients treated with both antibiotics and albumin therapy at a Canadian tertiary care hospital between 2003 and 2011 were retrospectively identified. Multivariate logistic regression was used to determine independent predictors of third-generation cephalosporin resistance and mortality.
Results:
In 192 patients, 25% of infections were nosocomial. Forty per cent (77 of 192) of infections were culture positive; of these, 19% (15 of 77) were resistant to third-generation cephalosporins. The prevalence of cephalosporin resistance was 8% with community-acquired infections, 17% with health care-associated infections and 41% with nosocomial acquisition. Nosocomial acquisition of infection was the only predictor of resistance to third-generation cephalosporins (OR 4.0 [95% CI 1.04 to 15.2]). Thirty-day mortality censored for liver transplantation was 27% (50 of 184). In the 77 culture-positive patients, resistance to third-generation cephalosporins (OR 5.3 [1.3 to 22]) and the Model for End-stage Live Disease score (OR 1.14 [1.04 to 1.24]) were independent predictors of 30-day mortality.
Conclusions:
Third-generation cephalosporin-resistant SBP is a common diagnosis and has an effect on clinical outcomes. In an attempt to reduce the mortality associated with resistance to empirical therapy, high-risk subgroups should receive broader empirical antibiotic coverage.
Insights
Third-generation cephalosporin-resistant spontaneous bacterial peritonitis (SBP) is common in cirrhosis patients in North America. This resistance increases mortality, necessitating broader empirical antibiotic coverage for high-risk groups.
Area of Science:
- Hepatology
- Infectious Diseases
- Clinical Microbiology
Background:
- Spontaneous bacterial peritonitis (SBP) is a frequent infection in cirrhosis patients.
- European data show high third-generation cephalosporin resistance, but North American data are limited.
Purpose of the Study:
- To determine the prevalence of third-generation cephalosporin-resistant SBP in Canada.
- To identify predictors and clinical impact of resistant SBP.
- To contextualize findings with existing literature.
Main Methods:
- Retrospective analysis of SBP patients treated with antibiotics and albumin (2003-2011).
- Multivariate logistic regression to identify predictors of resistance and mortality.
Main Results:
- 25% of SBP infections were nosocomial; 19% of culture-positive SBP were resistant to third-generation cephalosporins.
- Nosocomial acquisition predicted resistance (OR 4.0).
- Resistance and MELD score predicted 30-day mortality (OR 5.3 and 1.14, respectively).
Conclusions:
- Third-generation cephalosporin-resistant SBP is prevalent and impacts outcomes.
- High-risk patients may benefit from broader empirical antibiotic therapy to reduce mortality.
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