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Open Access Research article

Evolving epidemiology and antimicrobial resistance in spontaneous bacterial peritonitis: a two-year observational study

Lionel Piroth12*, André Pechinot23, Vincent Di Martino4, Yves Hansmann5, Alain Putot1, Isabelle Patry6, Tahar Hadou7, Benoit Jaulhac8, Catherine Chirouze9, Christian Rabaud10, Alain Lozniewski7, Catherine Neuwirth23, Pascal Chavanet12 and Anne Minello11

Author Affiliations

1 Département d’Infectiologie, CHU Dijon, Dijon, France

2 Université de Bourgogne, Dijon, France

3 Laboratoire de Bactériologie, CHU Dijon, France

4 Service d’Hépato-Gastro-Entérologie, CHU Besançon, France

5 Service de Maladies Infectieuses et Tropicales, CHU Strasbourg, Strasbourg, France

6 Laboratoire de Bactériologie, CHU Besançon, France

7 Laboratoire de Bactériologie, CHU Nancy, France

8 Laboratoire de Bactériologie, CHU Strasbourg, France

9 Service de Maladies Infectieuses et Tropicales, CHU Besançon, France

10 Service de Maladies Infectieuses et Tropicales, CHU Nancy, France

11 Service d’Hépato-Gastro-Entérologie, CHU Dijon, France

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BMC Infectious Diseases 2014, 14:287  doi:10.1186/1471-2334-14-287

Published: 23 May 2014

Abstract

Background

Current recommendations for empirical antimicrobial therapy in spontaneous bacterial peritonitis (SBP) are based on quite old trials. Since microbial epidemiology and the management of patients have changed, whether these recommendations are still appropriate must be confirmed.

Methods

An observational study that exhaustively collected the clinical and biological data associated with positive ascitic fluid cultures was conducted in four French university hospitals in 2010–2011.

Results

Two hundred and sixty-eight documented positive cultures were observed in 190 cirrhotic patients (median age 61.5 years, 58.5% Child score C). Of these, 57 were classified as confirmed SBP and 140 as confirmed bacterascites. The predominant flora was Gram-positive cocci, whatever the situation (SBP, bacterascites, nosocomial/health-care related or not). Enteroccocci (27.7% E. faecium) were isolated in 24% of the episodes, and in 48% from patients receiving quinolone prophylaxis. E. coli were susceptible to amoxicillin-clavulanate and to third-generation cephalosporins in 62.5% and 89.5% of cases, respectively. No single antibiotic allowed antimicrobial coverage of more than 60%. Only combinations such as amoxicillin + third-generation cephalosporin or cotrimoxazole allowed coverage close to 75-80% in non-nosocomial episodes. Combinations based on broader spectrum antibiotics should be considered for empirical therapy of nosocomial infections.

Conclusions

Our study confirmed the changing spectrum of pathogens in SBP and bacterascites, and the need for more complex antibiotic strategies than those previously recommended. Our findings also underline the need for new clinical trials conducted in the current epidemiological context.

Keywords:
Bacterascites; Spontaneous bacterial peritonitis; Epidemiology; Antibiotic susceptibility; Resistance