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DOI: 10.1055/s-0033-1347428
Microbial epidemiology in cirrhotic patients with spontaneous bacterial peritonitis in Vienna
Introduction: Spontaneous bacterial peritonitis (SBP) is associated with high mortality in cirrhotic patients with ascites. Since microbial epidemiology may vary across Europe, specific data on isolated species patients with SBP are crucial for therapeutic recommendations.
Methodology: Clinical and laboratory data of cirrhotic patients undergoing paracentesis at the Medical University of Vienna between 2006 – 2011 were recorded. Ascitic fluid was analysed including hematocrit, polymorphic nuclear (PMN) cell count, protein concentration, and aerobic/anaerobic cultures. SBP was defined as a PMN > 250/µL.
Results: Among 1741 paracenteses (57 ± 11 years; 70% male; alcoholic:55%, viral:19%), 275(15.8%) were diagnosed SBP with 88(32.0%) showing a positive bacterial culture. Gram-positive (G+) bacteria were diagnosed in 65% and Gram-negative (G-) bacteria in 27% of all cultures, with the most common specimens being Staphylococci spp.(33%), Enterococci spp.(19%), E. coli spp.(14%) and Streptococci spp.(11%). When comparing 2006 – 2008 and 2009 – 2011, a marked shift from Gram-negative to Gram-positive bacteria, mainly due to an increase of Enterococci species from 18.3% to 29.5%, was found. The prevalence of multidrug-resistant bacteria was low, with MRSA, ESBL and VRE accounting for 0%,1% and 1% of all positive cultures during 2006 – 2008 and for 3%,3% and 2% during 2009 – 2011, respectively. In in-patient paracenteses SBP was diagnosed more often (17.0% vs. 12.3%) than in out-patients and was mainly caused by Gram-positive bacteria (G+: 64% vs. G+: 28%; p < 0.001). Most commonly used antibiotics for empirical SBP therapy were betalactam-antibiotics (23%), cephalosporins (21%) and chinolons (19%). When isolated species were sensible to empiric first-line therapy, both 1-week resolution rate (68.4% vs. 8.0%; p < 0.001) and 1-month mortality (29.8% vs. 64.0%; p = 0.005) of SBP were significantly improved. Betalactam-antibiotics produced higher 1-week SBP resolution rates (64.3% vs. 35.8%; p = 0.012) than cephalosporines.
Conclusion: SBP is increasingly caused by gram-positive bacteria, especially Enterococci spp. The incidence of multidrug-resistant bacteria in Vienna is low. Since mortality is significantly influenced by effective empiric therapy, Betalactam-antibiotics should be preferred because of the local germ epidemiology and higher SBP resolution rates.