title: Changing epidemiology and predictors of mortality in patients with spontaneous bacterial peritonitis at a liver transplant unit.
abstract: OBJECTIVE
  To determine whether antimicrobial resistance in pathogens and outcome in patients with spontaneous bacterial peritonitis (SBP) has evolved over time.
  
  
  METHODS
  Sixty-one consecutive episodes of SBP were studied in patients with end-stage liver disease undergoing evaluation for liver transplantation between 1991 and 2001. Patients were dichotomized into a cohort between 1991 and 1995 (the earlier cohort) and 1996-2001 (the later cohort).
  
  
  RESULTS
  Overall, 19% of all bacteria were multiply-antibiotic resistant. The frequency of multiple-antibiotic resistance in bacteria increased from 8.3% to 38.5% in the earlier as compared to the later cohort (P = 0.07). Overall, mortality at 30 days in the study patients was 26% and had remained unchanged between the two cohorts. The mortality rate was significantly higher in patients with multiply-antibiotic-resistant bacteria than in those with other bacteria (P = 0.045). However, the Child-Pugh score (P = 0.003), and renal failure (P = 0.04) were the only independently significant predictors of mortality in patients with SBP.
  
  
  CONCLUSIONS
  Mortality in patients with end-stage liver disease who developed SBP has remained unchanged over the last decade. Although multiple-antibiotic resistance in bacteria causing SBP has increased over time, the severity of hepatic and renal dysfunction were the predominant determinants of outcome in these patients.
authors.affiliation: Veterans Affairs Medical Center, Pittsburgh, PA 15240, USA. nis5+@pitt.edu
authors.forename: N
authors.initials: N
authors.lastname: Singh
authors.forename: M M
authors.initials: MM
authors.lastname: Wagener
authors.forename: T
authors.initials: T
authors.lastname: Gayowski
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology* / Q000401:mortality*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000453:epidemiology* / Q000401:mortality*