title: Third-generation cephalosporin-resistant spontaneous bacterial peritonitis: a single-centre experience and summary of existing studies.
abstract: BACKGROUND
  Spontaneous bacterial peritonitis (SBP) is the most prevalent bacterial infection in patients with cirrhosis. Although studies from Europe have reported significant rates of resistance to third-generation cephalosporins, there are limited SBP-specific data from centres in North America.
  
  
  OBJECTIVE
  To evaluate the prevalence of, predictors for and clinical impact of third-generation cephalosporin-resistant SBP at a Canadian tertiary care centre, and to summarize the data in the context of the existing literature.
  
  
  METHODS
  SBP patients treated with both antibiotics and albumin therapy at a Canadian tertiary care hospital between 2003 and 2011 were retrospectively identified. Multivariate logistic regression was used to determine independent predictors of third-generation cephalosporin resistance and mortality.
  
  
  RESULTS
  In 192 patients, 25% of infections were nosocomial. Forty per cent (77 of 192) of infections were culture positive; of these, 19% (15 of 77) were resistant to third-generation cephalosporins. The prevalence of cephalosporin resistance was 8% with community-acquired infections, 17% with health care-associated infections and 41% with nosocomial acquisition. Nosocomial acquisition of infection was the only predictor of resistance to third-generation cephalosporins (OR 4.0 [95% CI 1.04 to 15.2]). Thirty-day mortality censored for liver transplantation was 27% (50 of 184). In the 77 culture-positive patients, resistance to third-generation cephalosporins (OR 5.3 [1.3 to 22]) and the Model for End-stage Live Disease score (OR 1.14 [1.04 to 1.24]) were independent predictors of 30-day mortality.
  
  
  CONCLUSIONS
  Third-generation cephalosporin-resistant SBP is a common diagnosis and has an effect on clinical outcomes. In an attempt to reduce the mortality associated with resistance to empirical therapy, high-risk subgroups should receive broader empirical antibiotic coverage.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chaulk
authors.forename: Michelle
authors.initials: M
authors.lastname: Carbonneau
authors.forename: Hina
authors.initials: H
authors.lastname: Qamar
authors.forename: Adam
authors.initials: A
authors.lastname: Keough
authors.forename: Hsiu-Ju
authors.initials: HJ
authors.lastname: Chang
authors.forename: Mang
authors.initials: M
authors.lastname: Ma
authors.forename: Deepali
authors.initials: D
authors.lastname: Kumar
authors.forename: Puneeta
authors.initials: P
authors.lastname: Tandon
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D002170:Canada / Q000453:epidemiology; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000494:pharmacology*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010538:Peritonitis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D015995:Prevalence; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins