Community-acquired vs. nosocomial spontaneous bacterial peritonitis in patients with liver cirrhosis.
OBJECTIVE
Spontaneous bacterial peritonitis (SBP) is a common complication in patients with end-stage liver disease, but reports comparing community-acquired SBP (CA-SBP) with nosocomial SBP (N-SBP) are rare. This study compared the clinical characteristics, microbiological characteristics, and treatment outcomes of patients with CA-SBP and N-SBP.


METHODS
Records for 248 patients (173 men, 75 women) with cirrhosis who experienced SBP were retrospectively reviewed.


RESULTS
The study population included 202 (81.5%) patients with CA-SBP and 46 (18.5%) patients with N-SBP. Patients with CA-SBP or N-SBP showed no significant differences in baseline or microbiological characteristics, except for a high frequency of previous SBP history in the N-SBP population (P=0.020). During hospitalization, antibiotic switching and in-hospital mortality were significantly higher for patients with N-SBP than CA-SBP (35.6% vs. 8.9%; P=0.001 and 30.4% vs. 12.9%; P=0.028). There were 202 (81.5%) deaths during the follow-up period, with longer overall survival time in patients with CA-SBP (7.9 vs. 3.9 months; P=0.041). However, time to recurrence was not significantly different between the two groups (4.7 vs. 3.6 months; P=0.910).


CONCLUSIONS
N-SBP was significantly associated with increased antibiotic switching, higher in-hospital mortality and shorter overall survival. Third-generation cephalosporin may be inappropriate as first-line empirical antibiotics for patients with N-SBP.
Young Eun
YE
Chon
Seung Up
SU
Kim
Chun Kyon
CK
Lee
Jun Yong
JY
Park
Do Young
DY
Kim
Kwang-Hyub
KH
Han
Chae Yoon
CY
Chon
Sinyoung
S
Kim
Kyu Sik
KS
Jung
Sang Hoon
SH
Ahn
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001202:Ascitic Fluid / Q000382:microbiology; D001424:Bacterial Infections / Q000188:drug therapy / Q000401:mortality*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000401:mortality*; D003428:Cross Infection / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000188:drug therapy / Q000401:mortality*; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents