Altered Pathogen Spectrum of Spontaneous Bacterial Peritonitis in Patients Treated With Proton Pump Inhibitors

Area of Science:

• Gastroenterology
• Infectious Diseases
• Microbiology

Background:

• Proton pump inhibitor (PPI) treatment is known to alter gut microbiota composition.
• These gut microbiota changes may influence the pathogens causing spontaneous bacterial peritonitis (SBP) in cirrhosis patients.

Purpose of the Study:

• To investigate the impact of PPI treatment on the spectrum of pathogens responsible for SBP in cirrhosis patients.
• To determine if PPI use is associated with specific changes in bacterial profiles of SBP.

Main Methods:

• Analysis of culture-positive SBP cases from 227 cirrhosis patients across two German tertiary care centers.
• Comparison of pathogen spectrum between patients on PPI treatment and those not on PPI treatment.
• Logistic regression analysis to identify independent predictors of SBP pathogen profiles.

Main Results:

• Gram-positive bacteria were significantly more prevalent in the PPI group (62.1%) compared to the non-PPI group (34.0%).
• Increased abundances of Enterococcus spp., Streptococcus spp., and Staphylococcus aureus were observed in PPI users.
• Gram-negative bacteria, particularly E. coli, were more frequent in the non-PPI group (64.0% vs. 40.7%).
• PPI use was an independent predictor of gram-positive SBP, even after adjusting for other factors.

Conclusions:

• PPI treatment is associated with a significant increase in gram-positive pathogens, such as Enterococcus spp., in SBP.
• These findings highlight a shift in the SBP pathogen spectrum related to PPI use.
• Understanding this shift can inform and guide empiric antibiotic therapy strategies for SBP in cirrhosis patients.