Third-generation cephalosporin-resistant spontaneous bacterial peritonitis: A single-centre experience and summary of existing studies
Third-generation cephalosporin-resistant spontaneous bacterial peritonitis: A single-centre experience and summary of existing studies
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DOI：
10.1155/2014/429536
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发表时间：
2014-02-01
期刊：
影响因子：
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通讯作者：
Tandon, Puneeta
中科院分区：
文献类型：
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作者：
Chaulk, Jennifer;Carbonneau, Michelle;Tandon, Puneeta
背景：自发性细菌性腹膜炎(SBP)是肝硬变患者最常见的细菌感染。尽管来自欧洲的研究报告了对第三代头孢菌素的显著耐药率，但来自北美中心的SBP特异性数据有限。目的：评估加拿大三级护理中心对第三代头孢菌素耐药SBP的患病率、预测因素和临床影响，并结合现有文献对数据进行总结。方法：对2003至2011年间在加拿大三级护理医院接受抗生素和白蛋白治疗的SBP患者进行回顾性鉴定。多因素Logistic回归分析确定了第三代头孢菌素耐药性和死亡率的独立预测因素。40%的感染(192例中77例)培养阳性；其中19%(77例中15例)对第三代头孢菌素耐药。社区获得性感染的头孢菌素耐药发生率为8%，医疗保健相关感染的耐药率为17%，医院获得性感染的耐药率为41%。院内感染是对第三代头孢菌素耐药的唯一预测因素(OR 4.0[95%CI 1.04~15.2])。肝移植后30天的死亡率为27%(184例中有50例)。在77例培养阳性患者中，对第三代头孢菌素耐药(OR 5.3[1.3至22])和终末期肝病模型评分(OR 1.14[1.04至1.24])是30天死亡率的独立预测因素。结论：第三代头孢菌素耐药SBP是一种常见的诊断，并对临床结果有影响。为了减少与经验性治疗耐药相关的死亡率，高危亚组应该接受更广泛的经验性抗生素覆盖。
BACKGROUND: Spontaneous bacterial peritonitis (SBP) is the most prevalent bacterial infection in patients with cirrhosis. Although studies from Europe have reported significant rates of resistance to third-generation cephalosporins, there are limited SBP-specific data from centres in North America.OBJECTIVE: To evaluate the prevalence of, predictors for and clinical impact of third-generation cephalosporin-resistant SBP at a Canadian tertiary care centre, and to summarize the data in the context of the existing literature.METHODS: SBP patients treated with both antibiotics and albumin therapy at a Canadian tertiary care hospital between 2003 and 2011 were retrospectively identified. Multivariate logistic regression was used to determine independent predictors of third-generation cephalosporin resistance and mortality.RESULTS: In 192 patients, 25% of infections were nosocomial. Forty per cent (77 of 192) of infections were culture positive; of these, 19% (15 of 77) were resistant to third-generation cephalosporins. The prevalence of cephalosporin resistance was 8% with community-acquired infections, 17% with health care-associated infections and 41% with nosocomial acquisition. Nosocomial acquisition of infection was the only predictor of resistance to third-generation cephalosporins (OR 4.0 [95% CI 1.04 to 15.2]). Thirty-day mortality censored for liver transplantation was 27% (50 of 184). In the 77 culture-positive patients, resistance to third-generation cephalosporins (OR 5.3 [1.3 to 22]) and the Model for End-stage Live Disease score (OR 1.14 [1.04 to 1.24]) were independent predictors of 30-day mortality.CONCLUSION: Third-generation cephalosporin-resistant SBP is a common diagnosis and has an effect on clinical outcomes. In an attempt to reduce the mortality associated with resistance to empirical therapy, high-risk subgroups should receive broader empirical antibiotic coverage.