Clinical significance of nosocomial spontaneous bacterial peritonitis in liver cirrhosis patients and impact of the 3rd generation cephalosporin resistance of Gram-negative bacilli on the outcome
Abstract number: P812
Cheong H.S., Wi Y.M., Kim E.S., Kang C.I., Chung D.R., Peck K.R., Lee N.Y., Song J-H.
Background: There have been few reports of the aetiologies and treatment outcome for nosocomial spontaneous bacterial peritonitis (SBP) in liver cirrhosis (LC) patients.
Objectives and Methods: We performed a retrospective cohort study to compare the microbiological and clinical characteristics and outcome between nosocomial and community-acquired SBP in LC patients. All cases of SBP, in which culture was proven at Samsung Medical Center from Jan. 2000 to Jun. 2007 were included. Medical records and laboratory data were reviewed. Nosocomial SBP was defined as SBP diagnosed after 72 hours of hospitalisation.
Results: A total of 236 patients with SBP were enrolled (mean age, 56.6±10.7 years; male/female, 166/70). Nosocomial and community-acquired SBP were 126 and 110 cases, respectively. Among 239 microorganisms isolated, Escherichia coli accounted for 43.2%, Klebsiella spp. 14%, Streptococcus spp. 9.7%, Enterococcus spp. 8.1% and Staphylococcus aureus 5.1%. The overall mortality rate of nosocomial SBP was higher than that of community-acquired SBP (58.7% vs. 37.3%, p = 0.001). Nosocomial isolates of Gram-negative bacilli (GNB) were significantly more resistant to 3rd generation cephalosporin (42.1% vs. 10.0%, p < 0.001) and quinolone (30.9% vs. 50.0%, p = 0.003) than community isolates. Multivariate analysis revealed that nosocomial infection, concomitant hepatocellular carcinoma, presentation with shock, elevated creatinine and resistance to 3rd generation cephalosporin of GNB were significant risk factors for the 30-day mortality in SBP.
Conclusions: Nosocomial SBP has a poorer outcome than community-acquired SBP. The resistance to the 3rd generation cephalosporin of GNB, which is more frequent in nosocomial SBP than in community-acquired SBP, adversely affects the outcome of SBP in LC patients.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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