title: Evolving epidemiology and antimicrobial resistance in spontaneous bacterial peritonitis: a two-year observational study.
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.
authors.affiliation: Département d'Infectiologie, CHU Dijon, Dijon, France. lionel.piroth@chu-dijon.fr.
authors.forename: Lionel
authors.initials: L
authors.lastname: Piroth
authors.forename: André
authors.initials: A
authors.lastname: Pechinot
authors.forename: Vincent
authors.initials: V
authors.lastname: Di Martino
authors.forename: Yves
authors.initials: Y
authors.lastname: Hansmann
authors.forename: Alain
authors.initials: A
authors.lastname: Putot
authors.forename: Isabelle
authors.initials: I
authors.lastname: Patry
authors.forename: Tahar
authors.initials: T
authors.lastname: Hadou
authors.forename: Benoit
authors.initials: B
authors.lastname: Jaulhac
authors.forename: Catherine
authors.initials: C
authors.lastname: Chirouze
authors.forename: Christian
authors.initials: C
authors.lastname: Rabaud
authors.forename: Alain
authors.initials: A
authors.lastname: Lozniewski
authors.forename: Catherine
authors.initials: C
authors.lastname: Neuwirth
authors.forename: Pascal
authors.initials: P
authors.lastname: Chavanet
authors.forename: Anne
authors.initials: A
authors.lastname: Minello
mesh_terms: D000368:Aged; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001202:Ascitic Fluid / Q000382:microbiology; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology*; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D004926:Escherichia coli / Q000187:drug effects / Q000472:pathogenicity; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010538:Peritonitis / Q000453:epidemiology* / Q000382:microbiology*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D019980:Amoxicillin-Potassium Clavulanate Combination