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DOI: 10.1055/s-0037-1604848
The clinical impact of multidrug resistance in spontaneous bacterial peritonitis
Publication History
Publication Date:
02 August 2017 (online)
Background&Aims:
Spontaneous bacterial peritonitis (SBP) is a severe complication of decompensated cirrhosis and clinical diagnosis can be difficult due to late onset of symptoms. Outcome of patients with cirrhosis is especially poor in case of colonisation or infection with multidrug-resistant bacteria (MDR). To date, there is no characterization of patients with SBP due to MDR (MDR-SBP).
Methods:
Between December 2011 and August 2016, 136 patients were diagnosed with spontaneous bacterial peritonitis and screened for multidrug-resistant bacteria (multidrug-resistant Gram-negative bacteria, vancomycin-resistant enterococci or methicillin-resistant staphylococcus aureus) at the tertiary liver transplant center at University Hospital Frankfurt, Germany. In this retrospective analysis, risk factors for fatal outcome were evaluated using multivariate regression analysis, and competing-risk analysis was performed on patients with MDR-SBP.
Results:
23/136 patients (16.9%) were diagnosed with MDR-SBP. 17/23 (69.9%) patients died, with sepsis being the leading causative in 9/23 patients (39.1%), and death due to other reasons in 7/24 patients (30.4%). MELD score was an independent predictor for survival in all patients with SBP (p < 0.001), however, in patients with MDR-SBP this was not the case (p = 0.102). Death due to sepsis was significantly increased in patients with MDR-SBP (p < 0.001). Surprisingly, this was not the case 30 d after diagnosis of SBP (p = 0.127). MELD score (p = 0.129) and CLIF-AD score (p = 0.166) did not differ in patients with MDR-SBP.
Discussion:
Survival is impaired in patients with MDR-SBP, independently from liver function. Lethal sepsis should be expected with a latency of several weeks. Adjustment of antibiotic therapy may be warranted, and consultation of an antibiotic stewardship team is recommended.