Clinical characteristics and outcomes of spontaneous bacterial peritonitis caused by Enterobacter species versus Escherichia coli: a matched case-control study

Microbiological Characteristics and Antibiotic Sensitivity in Patients with Nosocomial Spontaneous Bacterial Peritonitis Caused by Escherichia coli: A Multicenter Study

Escherichia coli is a prevalent causative pathogen of spontaneous bacterial peritonitis (SBP). In this retrospective study, we investigated the microbiological characteristics and antibiotic susceptibility of E. coli clinical isolates obtained from liver cirrhosis patients suffering from nosocomial SBP. Our results showed that extended-spectrum β-lactamase (ESBL)-producing E. coli accounted for 47% of the cases, while 62% of the isolates were multi-drug resistant (MDR) pathogens. ESBL-producing and MDR isolates showed high incidences of resistance to third-generation cephalosporins, but they displayed susceptibility to carbapenems, β-lactamase inhibitors, and aminoglycosides. Importantly, liver cirrhosis patients with MDR E. coli SBP showed a significantly higher death rate than patients with non-MDR infections (P = 0.021). The 30-day mortality of nosocomial SBP was independently correlated with female gender [odds ratio (OR) = 5.200, 95% confidence interval (CI) = 1.194-22.642], liver failure (OR = 9.609, 95% CI = 1.914-48.225), hepatocellular carcinoma (OR = 8.176, 95% CI = 2.065-32.364), hepatic encephalopathy (OR = 8.176, 95% CI = 2.065-32.364), model of end-stage liver disease score (OR = 1.191, 95% CI = 1.053-1.346), white blood cell count (OR = 0.847, 95% CI = 0.737-0.973), and ascites polymorphonuclear (OR = 95.903, 95% CI = 3.410-2697.356). In conclusion, third-generation cephalosporins may be inappropriate for empiric treatment of nosocomial SBP caused by E. coli, due to the widespread presence of ESBLs and high incidence of MDR pathogens.

Spontaneous bacterial and fungal peritonitis in patients with liver cirrhosis: A literature review

Spontaneous bacterial (SBP) and spontaneous fungal peritonitis (SFP) can be a life-threatening infection in patients with liver cirrhosis (LC) and ascites. One of the possible mechanisms of developing SBP is bacterial translocation. Although the number of polymorphonuclear cells in the culture of ascitic fluid is diagnostic for SBP, secondary bacterial peritonitis is necessary to exclude. The severity of underlying liver dysfunction is predictive of developing SBP; moreover, renal impairment and infections caused by multidrug-resistant (MDR) organism are associated with a fatal prognosis of SBP. SBP is treated by antimicrobials, but initial empirical treatment may not succeed because of the presence of MDR organisms, particularly in nosocomial infections. Antibiotic prophylaxis is recommended for patients with LC at a high risk of developing SBP, gastrointestinal bleeding, or a previous episode of SBP, but the increase in the risk of developing an infection caused by MDR organisms is a serious concern globally. Less is known about SFP in patients with LC, but the severity of underlying liver dysfunction may increase the hospital mortality. SFP mortality has been reported to be higher than that of SBP partially because the difficulty of early differentiation between SFP and SBP induces delayed antifungal therapy for SFP.