Abstract
Background/aims
Spontaneous bacterial peritonitis (SBP) is a life-threatening complication of advanced
cirrhosis. By studying the susceptibility of isolated organisms and analyzing empirical
antibiotic therapy combined with clinical outcomes, we aimed to find an improved empirical
antibiotic therapy by considering the individual acute-on-chronic liver failure (ACLF)
grade for patients with or without sepsis.
Methods
Clinical outcomes of 182 patients were assessed retrospectively with multivariable
regression analysis. Each of the 223 isolates was individually evaluated regarding
susceptibility results and intrinsic resistances.
Results
Piperacillin/tazobactam had the highest antimicrobial susceptibility among monotherapies/fixed
combinations, which was significantly lower than combination therapies such as meropenem-linezolid
(75.3% vs. 98.5%, P < 0.001). The sensitivity of pathogens to empirical antibiotic
therapy correlated with significantly lower inpatient mortality (18.9% vs. 37.0%,
P = 0.018), shorter inpatient stay (16.3 ± 10.2 vs. 26.4 ± 21.0 days, P = 0.053) and
shorter intensive care treatment (2.1 ± 4.5 vs. 7.9 ± 15.4 days, P = 0.016). The largest
difference of mortality was observed in patients with ACLF grade 3 (54.5% vs. 73.1%
[sensitive vs. non-sensitive]).
Conclusion
All SBP patients benefited from efficient empirical antibiotic therapy, regarding
the reduced inpatient mortality and complications. For SBP patients with ACLF grade
3 without sepsis, the combination therapy with meropenem-linezolid may be suitable
considering the susceptibility results and the concentration in the peritoneal cavity.
Keywords
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Article info
Publication history
Published online: March 07, 2019
Accepted:
February 25,
2019
Received:
October 12,
2018
Identification
Copyright
© 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
ScienceDirect
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- Antibiotic therapy for spontaneous bacterial peritonitis in acute-on-chronic liver failure: Handle with careDigestive and Liver DiseaseVol. 52Issue 1
- PreviewWe have read with great interest the paper by Wieser et al. [1] on the empirical antibiotic therapy in patients with spontaneous bacterial peritonitis (SBP) and acute-on-chronic liver failure (ACLF). The issue is of interest, since bacterial infection represents the most common trigger factor for the onset on ACLF in cirrhosis, often requiring intensive care management [2].
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