Nosocomial and Community-Acquired Spontaneous Bacterial Peritonitis in patients with liver cirrhosis in China: Comparative Microbiology and Therapeutic Implications

Lei Shi,Fusheng Wang,Bo Tu,Yanan Liu,Yangxin Xie,Suxia Liu,Xin Zhang,Lei Wei,Zhe Xu,Xinhua Wang,Enqiang Qin,Dan Wu,Liying Liu,Peng Zhao

doi:10.1038/srep46025

Abstract

Spontaneous bacterial peritonitis (SBP) is a common complication of liver cirrhosis. This study was performed to compare the microbiological characteristics of nosocomial and community-acquired episodes of bacterial peritonitis in China. Five hundred and seventy-five strains were isolated from the ascitic fluid of cirrhotic patients from the Beijing 302 Hospital from January 2014 to December 2014. The patients in the community-acquired SBP (n = 264) and the nosocomial SBP (n = 311) groups exhibited significant differences in clinical symptoms (P < 0.01). In both groups, most of the bacteria were Escherichia coli, Klebsiella pneumoniae, coagulase-negative staphylococcus and Enterococcus. There were more frequent gram-positive cocci (G+ C) in the nosocomial group (n = 170). Compared with the community-acquired group, the proportion of Enterococcus was significantly increased in the nosocomial group (9.0% vs. 16.6%, P < 0.05). The resistance rate of the main pathogenic bacteria to the recommended first-line drug in the guideline was very high. Community-acquired and nosocomial SBP groups exhibited differences in clinical symptoms and antibiotic susceptibility tests. Optimal treatments should be provided for these patients. We recommend that cefoperazone/sulbactam or piperacillin/tazobactam should be used for the empirical treatment of SBP.

Highlights

Based on the guidelines from American Association for the Study of Liver Diseases(AASLD) and European Association for the Study of the Liver(EASL), cefotaxime or a similar third-generation cephalosporin appears to be the treatment of choice for suspected Spontaneous bacterial peritonitis (SBP) and is used to cover 95% of the flora, which includes the 3 most common isolates: Escherichia coli, Klebsiella pneumoniae, and Streptococcal pneumoniae
Cheong et al found that the resistance to cephalosporins by gram-negative bacilli (G− B) was more common in nosocomial SBP than in community-acquired SBP
There were no significant differences in the causes of cirrhosis between the two groups (P = 0.95)

Summary

Introduction

Many studies have investigated the treatment efficacy of various antibiotics on SBP and found that the therapeutic consequences were related to the source of SBP infection[10]. Patients with nosocomial SBP exhibited a greater resistance to antibiotics than those with community-acquired SBP1,3. Cheong et al found that the resistance to cephalosporins by G− B was more common in nosocomial SBP than in community-acquired SBP. Patients who contracted nosocomial SBP had a poorer outcome than patients who contracted community-acquired SBP21. Based on Chinese population, our study aimed to investigate the bacterial spectrum of nosocomial and community-acquired SBPs and their antibiotic resistance. This outcome contributes to the understanding of the pathogenesis and improved treatment of SBP

Methods

Results

Conclusion