title: Clinical outcomes of spontaneous bacterial peritonitis due to extended-spectrum beta-lactamase-producing Escherichia coli or Klebsiella pneumoniae: a retrospective cohort study.
abstract: OBJECTIVE
  The aim of this study was to (1) evaluate the clinical outcomes of spontaneous bacterial peritonitis (SBP) due to extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli or Klebsiella pneumoniae (EK) and (2) investigate the relationship between the adequacy of initial antibiotic treatments and patient outcomes.
  
  
  METHODS
  We conducted a retrospective cohort study of cirrhotic patients with SBP caused by EK. We evaluated the 30-day mortality rate and used Cox proportional hazard models to identify risk factors for mortality.
  
  
  RESULTS
  Between January 2006 and December 2012, a total of 231 episodes of SBP due to EK were recorded. Among them, 52 were caused by ESBL-producing EK (ESBL-EK). The 30-day mortality rate was significantly higher in patients with SBP due to ESBL-EK than in those with non-ESBL-producing EK (non-ESBL-EK) (34.6 vs. 18.4 %, respectively; p = 0.013). Multivariate analysis revealed that ESBL production [adjusted HR (aHR) 1.82, 95 % confidence interval (CI) 1.00-3.31], nosocomial infection (aHR 2.24, 95 % CI 1.26-3.95), septic shock (aHR 4.84, 95 % CI 2.70-8.65), higher Child-Pugh score (aHR 1.57, 95 % CI 1.28-1.92), and higher Charlson comorbidity index (aHR 1.37, 95 % CI 1.15-1.64) were independent risk factors for 30-day mortality in the total cohort. When we analyzed patients with SBP due to ESBL-EK separately, septic shock (aHR 3.64, 95 % CI 1.40-9.77), accompanying bacteremia (aHR 3.71, 95 % CI 1.37-10.08), and hepatocellular carcinoma (aHR 3.21, 95 % CI 1.20-8.56) were independent risk factors.
  
  
  CONCLUSIONS
  Both 7- and 30-day mortalities for SBP due to ESBL-EK were significantly higher than for SBP due to non-ESBL-EK. Initial antibiotic choice was not associated with poor clinical outcomes in patients with SBP due to ESBL-EK.
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. nahani99@gmail.com.
authors.forename: Min Jae
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. khsongmd@gmail.com.
authors.forename: Kyoung-Ho
authors.initials: KH
authors.lastname: Song
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. naks79@gmail.com.
authors.forename: Nak-Hyun
authors.initials: NH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. pgchoe@gmail.com.
authors.forename: Pyoeng Gyun
authors.initials: PG
authors.lastname: Choe
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. wbpark1@snu.ac.kr.
authors.forename: Wan Beom
authors.initials: WB
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. bangmd@ymail.com.
authors.forename: Ji Hwan
authors.initials: JH
authors.lastname: Bang
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. yonathan@hanafos.com.
authors.forename: Eu Suk
authors.initials: ES
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. hswon1@snu.ac.kr.
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. ksbkhb@chollian.net.
authors.forename: Hong Bin
authors.initials: HB
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. hsleemd@snu.ac.kr.
authors.forename: Hyo-Suk
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. mdohmd@snu.ac.kr.
authors.forename: Myoung-Don
authors.initials: MD
authors.lastname: Oh
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. molder@unitel.co.kr.
authors.forename: Nam Joong
authors.initials: NJ
authors.lastname: Kim
keywords: Antibiotics; ESBL; Spontaneous bacterial peritonitis