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.
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.
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]).
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.
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- cute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis.Gastroenterology. 2013; 144 (37.e1–9): 1426-1437
- Predisposing factors in acute-on-chronic liver failure.Semin Liver Dis. 2016; 36: 167-173
- Acute-on-chronic liver failure: current concepts on definition, pathogenesis, clinicalmanifestations and potential therapeutic interventions.Expert Rev Gastroenterol Hepatol. 2011; 5: 523-537
- Clinical profile and predictors of mortality in patients of acute-on-chronic liver failure.Dig Liver Dis. 2012; 44: 166-171
- Safety and efficacy profile of G-CSF therapy in patients with acute on chronic liver failure.Dig Liver Dis. 2007; 39: 1071-1076
- Bacterial and fungal infections in acute-on-chronic liver failure: prevalence, characteristics and impact on prognosis.Gut. 2018; 67: 1870-1880
- Prevalence, predictors and impact of bacterial infection in acute on chronic liver failure patients.Dig Liver Dis. 2018; 50: 1225-1231
- Extensively drug-resistant bacteria are an independent predictive factor of mortality in 130 patients with spontaneous bacterial peritonitis or spontaneous bacteremia.World J Gastroenterol. 2016; 22: 4049-4056
- A real-world evaluation of repeat paracentesis-guided management of spontaneous bacterial peritonitis.J Clin Gastroenterol. 2017; 51: 278-284
- A randomized open label study of ‘imipenem vs. cefepime’ in spontaneous bacterial peritonitis.Liver Int. 2016; 36: 677-687
- Proton pump inhibitors do not increase the risk for recurrent spontaneous bacterial peritonitis in patients with cirrhosis.J Gastroenterol Hepatol. 2017; 32: 1064-1070
- Renal dysfunction is the most important independent predictor of mortality in cirrhotic patients with spontaneous bacterial peritonitis.Clin Gastroenterol Hepatol. 2011; 9: 260-265
- The 22/11 risk prediction model: a validated model for predicting 30-day mortality in patients with cirrhosis and spontaneous bacterial peritonitis.Am J Gastroenterol. 2013; 108: 1473-1479
- EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis.J Hepatol. 2018; 69: 406-460
- Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012.Hepatology (Baltimore, Md). 2013; 57: 1651-1653
- Cefotaxime is more effective than is ampicillin-tobramycin in cirrhotics with severe infections.Hepatology (Baltimore, Md). 1985; 5: 457-462
- Randomized, comparative study of oral ofloxacin versus intravenous cefotaxime in spontaneous bacterial peritonitis.Gastroenterology. 1996; 111: 1011-1017
- Two different dosages of cefotaxime in the treatment of spontaneous bacterial peritonitis in cirrhosis: results of a prospective, randomized, multicenter study.Hepatology (Baltimore, Md). 1995; 21: 674-679
- The empirical antibiotic treatment of nosocomial spontaneous bacterial peritonitis: results of a randomized, controlled clinical trial.Hepatology (Baltimore, Md). 2016; 63: 1299-1309
- Cefepime versus ceftazidime: considerations for empirical use in critically ill patients.Int J Antimicrob Agents. 2007; 29: 117-128
- An observational study on the epidemiology of respiratory tract bacterial pathogens and their susceptibility to four injectable beta-lactam antibiotics: piperacillin, piperacillin/tazobactam, ceftazidime and ceftriaxone.J Chemother (Florence, Italy). 2001; 13: 413-423
- Weight-based antibiotic dosing in a real-world European study of complicated skin and soft-tissue infections due to methicillin-resistant Staphylococcus aureus.Clin Microbiol Infect. 2015; 21: S40-S46
- EUCAST expert rules in antimicrobial susceptibility testing.Clin Microbiol Infect. 2013; 19: 141-160
- Efficacy and safety of tigecycline for the treatment of infectious diseases: a meta-analysis.Lancet Infect Dis. 2011; 11: 834-844
- Excess deaths associated with tigecycline after approval based on noninferiority trials.Clin Infect Dis. 2012; 54: 1699-1709
- Efficacy and safety of tigecycline: a systematic review and meta-analysis.J Antimicrob Chemother. 2011; 66: 1963-1971
- Linezolid pharmacokinetics and pharmacodynamics in clinical treatment.J Antimicrob Chemother. 2011; 66: iv7-iv15
- Peritoneal dialysis fluid concentrations of linezolid in the treatment of vancomycin-resistant Enterococcus faecium peritonitis.Pharmacotherapy. 2003; 23: 1322-1326
- Vancomycin: a review of population pharmacokinetic analyses.Clin Pharmacokinet. 2012; 51: 1-13
- Pharmacokinetics and pharmacodynamics of intravenous daptomycin during continuous ambulatory peritoneal dialysis.Clin J Am Soc Nephrol. 2011; 6: 1081-1088
- Beta-lactam dosing in critically ill patients with septic shock and continuous renal replacement therapy.Crit Care. 2014; 18: 227
- Pharmacokinetics of meropenem determined by microdialysis in the peritoneal fluid of patients with severe peritonitis associated with septic shock.Clin Pharmacol Ther. 2008; 83: 452-459
- Pharmacokinetics of linezolid in subjects with renal dysfunction.Antimicrob Agents Chemother. 2003; 47: 2775-2780
- Hematologic effects of linezolid: summary of clinical experience.Antimicrob Agents Chemother. 2002; 46: 2723-2726
- Daily cost of an intensive care unit day: the contribution of mechanical ventilation.Crit Care Med. 2005; 33: 1266-1271
Published online: March 07, 2019
Accepted: February 25, 2019
Received: October 12, 2018
© 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
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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.  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 .