Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice.
World J Gastroenterol
; 14(17): 2757-62, 2008 May 07.
Article
in En
| MEDLINE
| ID: mdl-18461661
ABSTRACT
AIM:
To verify the validity of the International Ascites Club guidelines for treatment of spontaneous bacterial peritonitis (SBP) in clinical practice.METHODS:
All SBP episodes occurring in a group of consecutive cirrhotics were managed accordingly and included in the study. SBP was diagnosed when the ascitic fluid polymorphonuclear (PMN) cell count was > 250 cells/mm3, and empirically treated with cefotaxime.RESULTS:
Thirty-eight SBP episodes occurred in 32 cirrhotics (22 men/10 women; mean age 58.6 +/- 11.2 years). Prevalence of SBP, in our population, was 17%. Ascitic fluid culture was positive in nine (24%) cases only. Eleven episodes were nosocomial and 71% community-acquired. Treatment with cefotaxime was successful in 59% of cases, while 41% of episodes required a modification of the initial antibiotic therapy because of a less-than 25% decrease in ascitic PMN count at 48 h. Change of antibiotic therapy led to the resolution of infection in 87% of episodes. Among the cases with positive culture, the initial antibiotic therapy with cefotaxime failed at a percentage (44%) similar to that of the whole series. In these cases, the isolated organisms were either resistant or with an inherent insufficient susceptibility to cefotaxime.CONCLUSION:
In clinical practice, ascitic PMN count is a valid tool for starting a prompt antibiotic treatment and evaluating its efficacy. The initial treatment with cefotaxime failed more frequently than expected. An increase in healthcare-related infections with antibiotic-resistant pathogens may explain this finding. A different first-line antibiotic treatment should be investigated.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Peritonitis
/
Bacterial Infections
/
Cefotaxime
/
Practice Guidelines as Topic
/
Liver Cirrhosis
/
Anti-Bacterial Agents
Type of study:
Etiology_studies
/
Guideline
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
World J Gastroenterol
Journal subject:
GASTROENTEROLOGIA
Year:
2008
Type:
Article
Affiliation country:
Italy