Evolving epidemiology and antimicrobial resistance in spontaneous bacterial peritonitis: a two-year observational study

BMC Infectious Diseases

Anne Minello⁷  Pascal Chavanet⁵  Catherine Neuwirth³  Alain Lozniewski²  Christian Rabaud^1,10  Catherine Chirouze¹  Benoit Jaulhac⁴  Tahar Hadou²  Isabelle Patry^1,11  Alain Putot⁸  Yves Hansmann⁹  Vincent Di Martino⁶  André Pechinot³  Lionel Piroth⁵ 

[1] Service de Maladies Infectieuses et Tropicales, CHU Besançon, France;Laboratoire de Bactériologie, CHU Nancy, France;Laboratoire de Bactériologie, CHU Dijon, France;Laboratoire de Bactériologie, CHU Strasbourg, France;Université de Bourgogne, Dijon, France;Service d’Hépato-Gastro-Entérologie, CHU Besançon, France;Service d’Hépato-Gastro-Entérologie, CHU Dijon, France;Département d’Infectiologie, CHU Dijon, Dijon, France;Service de Maladies Infectieuses et Tropicales, CHU Strasbourg, Strasbourg, France;Service de Maladies Infectieuses et Tropicales, CHU Nancy, France;Laboratoire de Bactériologie, CHU Besançon, France

关键词: Resistance;    Antibiotic susceptibility;    Epidemiology;    Spontaneous bacterial peritonitis;    Bacterascites;   

Others  :  1127720
DOI  :  10.1186/1471-2334-14-287

 received in 2014-01-16, accepted in 2014-05-14,  发布年份 2014

【 摘 要 】

Background

Current recommendations for empirical antimicrobial therapy in spontaneous bacterial peritonitis (SBP) are based on quite old trials. Since microbial epidemiology and the management of patients have changed, whether these recommendations are still appropriate must be confirmed.

Methods

An observational study that exhaustively collected the clinical and biological data associated with positive ascitic fluid cultures was conducted in four French university hospitals in 2010–2011.

Results

Two hundred and sixty-eight documented positive cultures were observed in 190 cirrhotic patients (median age 61.5 years, 58.5% Child score C). Of these, 57 were classified as confirmed SBP and 140 as confirmed bacterascites. The predominant flora was Gram-positive cocci, whatever the situation (SBP, bacterascites, nosocomial/health-care related or not). Enteroccocci (27.7% E. faecium) were isolated in 24% of the episodes, and in 48% from patients receiving quinolone prophylaxis. E. coli were susceptible to amoxicillin-clavulanate and to third-generation cephalosporins in 62.5% and 89.5% of cases, respectively. No single antibiotic allowed antimicrobial coverage of more than 60%. Only combinations such as amoxicillin + third-generation cephalosporin or cotrimoxazole allowed coverage close to 75-80% in non-nosocomial episodes. Combinations based on broader spectrum antibiotics should be considered for empirical therapy of nosocomial infections.

Conclusions

Our study confirmed the changing spectrum of pathogens in SBP and bacterascites, and the need for more complex antibiotic strategies than those previously recommended. Our findings also underline the need for new clinical trials conducted in the current epidemiological context.

【 授权许可】

   
2014 Piroth et al.; licensee BioMed Central Ltd.

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