Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice.
OBJECTIVE
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.


CONCLUSIONS
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.
Angeloni
Stefania
S
Department of Clinical Medicine, Sapienza University of Rome, Roma, Italy.
Leboffe
Cinzia
C
Parente
Antonella
A
Venditti
Mario
M
Giordano
Alessandra
A
Merli
Manuela
M
Riggio
Oliviero
O
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001202:Ascitic Fluid / Q000382:microbiology / Q000473:pathology; D001424:Bacterial Infections / Q000209:etiology / Q000382:microbiology / Q000473:pathology / Q000628:therapy*; D002439:Cefotaxime / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology; D010538:Peritonitis / Q000209:etiology / Q000382:microbiology / Q000473:pathology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D017211:Treatment Failure; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002439:Cefotaxime