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Patients with cirrhosis and SBP: Increase in multidrug-resistant organisms and complications
Hanwei Li1, Andreas Wieser2,3,4, Jiang Zhang1
1Department of Medicine II, Liver Center Munich, University Hospital, LMU Munich, Munich, Germany.
Background:
Spontaneous bacterial peritonitis (SBP) is a serious complication in patients with liver cirrhosis. In recent years, it has been postulated that the rate of multidrug-resistant organisms (MDROs) is increasing, especially in nosocomial SBP patients. Aim of the present work was to investigate this hypothesis and its possible clinical consequences.
Materials And Methods:
One hundred and three culture-positive patients between 2007 and 2014 were compared with 81 patients between 2015 and 2017, to study the change of microbiological profiles and their clinical consequences. The cirrhosis patients with bacterascites requiring treatment were included as well.
Results:
The most prevalent Gram-negative bacteria isolated from ascites were Enterobacterales (31.6%) and in Gram-positive pathogens Staphylococci (22.8%). There was a significant increase in MDROs (22.3% ICU 40.7%, P = .048), accompanied by an increased incidence of sepsis (from 21.4% to 37.0%, P = .021), hepatorenal syndrome (from 40.8% to 58.0%, P = .007) and the need of catecholamine therapy (from 21.4% to 38.8%, P = .036). Nosocomial origin correlated with higher MDRO proportion, more complications and lower antimicrobial susceptibility rates in 12 commonly used antibiotics. MDROs were confirmed as an isolated predictor for inpatient mortality and complications in multivariable logistic regression.
Conclusions:
The feeling in clinical practice that MDROs have increased in the last 11 years could be confirmed in our study in Munich, Germany. Nosocomial SBP correlated with significantly higher MDRO rates (nearly 50%) and complication rates. In our opinion, an antibiotic combination with comprehensive effect should be taken into account in nosocomial SBP patients in this region.
Insights
Multidrug-resistant organisms (MDROs) have increased in spontaneous bacterial peritonitis (SBP) patients, leading to more sepsis and complications. Nosocomial SBP is linked to higher MDRO rates and worse outcomes, necessitating broader antibiotic coverage.
Area of Science:
- Hepatology
- Infectious Diseases
- Clinical Microbiology
Background:
- Spontaneous bacterial peritonitis (SBP) is a severe complication in liver cirrhosis patients.
- An increasing prevalence of multidrug-resistant organisms (MDROs) in SBP, particularly nosocomial cases, has been suspected.
Purpose of the Study:
- To investigate the hypothesis of increasing MDRO rates in SBP.
- To assess the clinical consequences of changing microbiological profiles in SBP patients.
Main Methods:
- Comparison of microbiological data and clinical outcomes from 103 culture-positive SBP patients (2007-2014) with 81 patients (2015-2017).
- Inclusion of cirrhosis patients with bacterascites requiring treatment.
Main Results:
- Enterobacterales and Staphylococci were the most common pathogens.
- A significant rise in MDROs (22.3% to 40.7%) was observed, correlating with increased sepsis, hepatorenal syndrome, and need for catecholamine therapy.
- Nosocomial SBP was associated with higher MDRO rates, more complications, and reduced antibiotic susceptibility.
- MDROs independently predicted inpatient mortality and complications.
Conclusions:
- The study confirms an increase in MDROs in SBP patients over 11 years in Munich, Germany.
- Nosocomial SBP showed significantly higher MDRO and complication rates (nearly 50%).
- Empirical antibiotic therapy for nosocomial SBP should consider combinations with broad-spectrum activity in this region.
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