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. 2020 Sep 28;15(9):e0239470.
doi: 10.1371/journal.pone.0239470. eCollection 2020.

A retrospective analysis of cases of Spontaneous Bacterial Peritonitis in cirrhosis patients

Phillip Pasquale Santoiemma  1   2 , Omar Dakwar  2 , Michael Peter Angarone  1   2
Affiliations

A retrospective analysis of cases of Spontaneous Bacterial Peritonitis in cirrhosis patients

Phillip Pasquale Santoiemma et al. PLoS One. .

Abstract

Background & aims: Spontaneous Bacterial Peritonitis (SBP) is an infection in patients with cirrhosis and carries significant mortality. The management of SBP is evolving with the rise of multidrug resistant organisms. Our aim was to perform a retrospective analysis to determine if identification of bacteria in culture could aid in prognosis and provide information regarding optimal treatment.

Methods: We analyzed our 10-year experience of SBP in a single academic center (Northwestern Memorial Hospital). We obtained information regarding SBP prophylaxis, culture data and resistance patterns of bacteria, choice/duration of inpatient antibiotics, and key laboratory measurements and determined outcomes including mortality, hospital duration, and ICU stay.

Results: Patients with SBP had a 17.8% mortality and had culture positive SBP 34.4% of the time. Antimicrobial resistance was seen in 21.3% of cases and trended towards worsening mortality, with worsened mortality associated with first line use of piperacillin-tazobactam (p = 0.0001). Patients on SBP prophylaxis who developed SBP had improved mortality (p<0.0001) unless there was a positive culture, in which case patients had worsened mortality (p = 0.019). Patient with a higher PMN counts after repeat paracentesis had higher mortality (p = 0.02).

Conclusions: Our results show that SBP continues to be a morbid and deadly condition and identification of an organism is key in treatment. The standard initial antibiotic for SBP may need to be modified to reflect emerging resistant pathogens and gram-positive organisms. Further, antibiotic prophylaxis should be utilized only in select cases to prevent development of resistance.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Stepwise process of data mining starting with EDW patient data.
Fig 2
Fig 2. First line antibiotic choice.
Using Piperacillin/Tazobactam as the first line agent leads to statistically worsened mortality (p = 0.0001).
See this image and copyright information in PMC

References

    1. Borzio M, Salerno F, Piantoni L, et al. Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study. Dig Liver Dis 2001;33:41–8. 10.1016/s1590-8658(01)80134-1 - DOI - PubMed
    1. Bal CK, Daman R, Bhatia V. Predictors of fifty days in-hospital mortality in decompensated cirrhosis patients with spontaneous bacterial peritonitis. World J Hepatol 2016;8:566–72. 10.4254/wjh.v8.i12.566 - DOI - PMC - PubMed
    1. Hung TT, Hsieh CC, Tsai YH, CC. The long-term mortality of spontaneous bacterial peritonitis in cirrhotic patients: A 3-year nationwide cohort study. Turkish Journal of Gastroenterology 2015;26:159–62. 10.5152/tjg.2015.4829 - DOI - PubMed
    1. Lim KH, Potts JR, Chetwood J, et al. Long-term outcomes after hospitalization with spontaneous bacterial peritonitis. J Dig Dis 2015;16:228–40. 10.1111/1751-2980.12228 - DOI - PubMed
    1. Berg RD. Bacterial translocation from the gastrointestinal tract. Adv Exp Med Biol 1999;473:11–30. 10.1007/978-1-4615-4143-1_2 - DOI - PubMed

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