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Published on: October 15, 2014
Microbiology and antibiotic susceptibility patterns in spontaneous bacterial peritonitis: A study of two Dutch
Rosalie C Oey1, Robert A de Man1, Nicole S Erler2,3
11Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
Background:
Recent investigations suggest an increasing prevalence of Gram-positive and antibiotic-resistant bacteria causing spontaneous bacterial peritonitis (SBP), probably related to changes in antibiotic prescription patterns, in particular more widespread and long-term use of antibiotic prophylaxis with quinolones.
Objective:
The primary objective of this study was to assess potential changes in the microbiology of SBP in two patient cohorts studied at a 10-year interval. Further aims were to study prognostic factors and outcome of SBP.
Methods:
A retrospective double-cohort study, including all ascitic cultures from patients with cirrhosis obtained 2003-2005 and 2013-2014, was conducted.
Results:
In total 312 patients were included, 125 patients in the first and 187 patients in the second cohort. SBP was diagnosed in 132 of 840 analyzed ascitic fluid samples; 62 samples were culture positive. An increase of Gram-positive bacterial isolates was noted from 26% to 46% between cohorts (p = 0.122). The prevalence of multidrug-antibiotic-resistant pathogens increased from 25% to 32% (p = 0.350). Survival after SBP among the two cohorts was comparable.
Conclusion:
This single-center study in the Netherlands found a modest but nonsignificant increase in the proportion of patients with SBP caused by Gram-positive bacteria and multidrug-antibiotic-resistant bacteria over a 10-year period. Our findings differ from reported data in other countries and suggest empiric antibiotic prophylaxis and treatment of SBP should be based on national and regional microbiological findings and resistance patterns.
Insights
Spontaneous bacterial peritonitis (SBP) is increasingly caused by Gram-positive and antibiotic-resistant bacteria, a trend observed over a decade. Current antibiotic strategies for SBP may need reassessment based on evolving resistance patterns.
Area of Science:
- Hepatology and Infectious Diseases
- Microbiology and Antibiotic Resistance
Background:
- Growing concerns regarding Gram-positive and antibiotic-resistant bacteria in spontaneous bacterial peritonitis (SBP).
- Potential link between increased quinolone prophylaxis and shifts in bacterial pathogens causing SBP.
- Need to understand evolving SBP microbiology in clinical practice.
Purpose of the Study:
- To evaluate changes in SBP microbiology over a 10-year period.
- To identify prognostic factors and assess outcomes for SBP patients.
- To compare SBP microbiology between two distinct patient cohorts.
Main Methods:
- Retrospective analysis of ascitic fluid cultures from cirrhotic patients.
- Inclusion of two patient cohorts from 2003-2005 and 2013-2014.
- Comparison of microbiological data and patient outcomes between cohorts.
Main Results:
- An increase in Gram-positive bacterial isolates from 26% to 46% was observed.
- A rise in multidrug-antibiotic-resistant pathogens from 25% to 32% was noted.
- Survival rates following SBP were comparable between the two study periods.
Conclusions:
- A modest, though not statistically significant, increase in Gram-positive and multidrug-resistant bacteria causing SBP over 10 years.
- Findings contrast with international reports, highlighting regional variations in SBP microbiology.
- Recommendations for empiric SBP treatment and prophylaxis should align with local resistance patterns.
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