Prevalence and Predictors of Third-Generation Cephalosporin Resistance in the Empirical Treatment of Spontaneous Bacterial Peritonitis |
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Authors: | Dharma B Sunjaya Ryan J Lennon Vijay H Shah Patrick S Kamath Douglas A Simonetto |
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Institution: | 1. School of Graduate Medical Education, Mayo Clinic, Rochester, MN;2. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN;3. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN |
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Abstract: | ObjectiveTo better characterize the changing patterns of spontaneous bacterial peritonitis (SBP) in a tertiary academic center in the United States by identifying the prevalence of gram-positive organisms and cephalosporin resistance along with predictors of mortality and antibiotic drug resistance.Patients and MethodsWe reviewed 481 consecutive patients with SBP at Mayo Clinic in Rochester, Minnesota, from January 1, 2005, through December 31, 2016. Data on comorbid conditions, etiology of cirrhosis, factors predisposing to infection, and antimicrobial and antibiotic drug use were collected.ResultsWe identified 96 patients (20%) with culture-positive SBP requiring treatment (median age, 60 years; age range, 22-87 years; 44% men). Gram-positive organisms account for more than half of the cases. Overall resistance to third-generation cephalosporins was 10% (n=10). Risk factors for third-generation cephalosporin resistance include nosocomial acquisition, recent antibiotic drug use, and hepatocellular carcinoma. The negative predictive value for antibiotic drug resistance in the present model was 96% (70 of 73). Overall mortality at 30 and 90 days was 23% and 37%, respectively.ConclusionThese findings support the recent observation of a rising prevalence of gram-positive organisms in SBP. Despite the changing pattern, third-generation cephalosporins seem to provide adequate empirical treatment in patients with community-acquired and health care–associated SBP without hepatocellular carcinoma. |
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Keywords: | CNNA culture-negative neutrocytic ascites CA community acquired HCA health care associated HCC hepatocellular carcinoma HIV human immunodeficiency virus HR hazard ratio ICU intensive care unit MELD Model for End-Stage Liver Disease MRSA NA nosocomial acquisition NAFLD nonalcoholic fatty liver disease PMN polymorphonuclear neutrophil SBP spontaneous bacterial peritonitis SIRS systemic inflammation response system |
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