title: Antibiotic resistance in healthcare-related and nosocomial spontaneous bacterial peritonitis.
abstract: BACKGROUND
  Spontaneous bacterial peritonitis (SBP) can be life threatening in patients with liver cirrhosis. In contrast to community-acquired SBP, no standard treatment has been established for healthcare-related and nosocomial SBP.
  
  
  METHODS
  We prospectively collected healthcare-related and nosocomial SBP cases from March 2012 till February 2016 at the Department of Internal Medicine I of the University of Bonn and analysed the prevalence of antibiotic resistance among the isolated bacteria. SBP was diagnosed according to international guidelines. Ciprofloxacin, ceftriaxone and meropenem were used as reference substance for resistance to quinolones, third-generation cephalosporins and carbapenems, respectively.
  
  
  RESULTS
  Ninety-two SBP episodes in 86 patients were identified: 63 episodes (69%) were nosocomial. Escherichia coli, Klebsiella species, enterococci and streptococci were most frequently isolated. Frequencies of these microorganisms were comparable for healthcare-related and nosocomial SBP (14% vs. 11%, 14% vs. 8%, 14% vs. 5% and 10% vs. 6%, respectively). In general, antibiotic resistance was higher in isolates from nosocomial than from healthcare-related SBP (50% vs. 18% for quinolones, 30% vs. 11% for piperacillin-tazobactam; P > 0·05), but comparable concerning third-generation cephalosporins (30% vs. 33%). All microorganisms were sensitive to carbapenems apart from nosocomial infections with Enterococcus faecium (n = 3) and Candida albicans (n = 1) due to intrinsic resistance or lack of microbiological efficacy, respectively. No multidrug-resistant microorganisms were detected. Resistance to initial antibiotic treatment affected 30-day survival negatively (18% vs. 68%; P = 0·002).
  
  
  CONCLUSIONS
  Resistance to initial antibiotic treatment was associated with increased mortality. With resistance to cephalosporins being frequent, piperacillin-tazobactam or carbapenems might be preferred as treatment of SBP.
authors.affiliation: Department of Internal Medicine I, University of Bonn, Bonn, Germany.|German Center for Infection Research, partner site Bonn-Cologne, Bonn, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Lutz
authors.affiliation: Department of Internal Medicine I, University of Bonn, Bonn, Germany.|German Center for Infection Research, partner site Bonn-Cologne, Bonn, Germany.
authors.forename: Hans Dieter
authors.initials: HD
authors.lastname: Nischalke
authors.affiliation: Department of Internal Medicine I, University of Bonn, Bonn, Germany.|German Center for Infection Research, partner site Bonn-Cologne, Bonn, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Krämer
authors.affiliation: Department of Internal Medicine I, University of Bonn, Bonn, Germany.|German Center for Infection Research, partner site Bonn-Cologne, Bonn, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Goeser
authors.affiliation: Department of Internal Medicine I, University of Bonn, Bonn, Germany.|German Center for Infection Research, partner site Bonn-Cologne, Bonn, Germany.
authors.forename: Dominik J
authors.initials: DJ
authors.lastname: Kaczmarek
authors.affiliation: Department of Internal Medicine I, University of Bonn, Bonn, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schlabe
authors.affiliation: German Center for Infection Research, partner site Bonn-Cologne, Bonn, Germany.|Institute of Medical Microbiology, Immunology and Parasitology, University of Bonn, Bonn, Germany.
authors.forename: Marijo
authors.initials: M
authors.lastname: Parcina
authors.affiliation: Department of Internal Medicine I, University of Bonn, Bonn, Germany.|German Center for Infection Research, partner site Bonn-Cologne, Bonn, Germany.
authors.forename: Jacob
authors.initials: J
authors.lastname: Nattermann
authors.affiliation: German Center for Infection Research, partner site Bonn-Cologne, Bonn, Germany.|Institute of Medical Microbiology, Immunology and Parasitology, University of Bonn, Bonn, Germany.
authors.forename: Achim
authors.initials: A
authors.lastname: Hoerauf
authors.affiliation: Department of Internal Medicine I, University of Bonn, Bonn, Germany.|German Center for Infection Research, partner site Bonn-Cologne, Bonn, Germany.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Strassburg
authors.affiliation: Department of Internal Medicine I, University of Bonn, Bonn, Germany.|German Center for Infection Research, partner site Bonn-Cologne, Bonn, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Spengler
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents; D001424:Bacterial Infections / Q000150:complications / Q000382:microbiology; D002443:Ceftriaxone; D002939:Ciprofloxacin; D003428:Cross Infection; D024881:Drug Resistance, Bacterial; D016983:Enterococcus; D004927:Escherichia coli Infections / Q000150:complications / Q000382:microbiology*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000382:microbiology; D006801:Humans; D007710:Klebsiella Infections / Q000150:complications / Q000382:microbiology*; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications / Q000382:microbiology*; D011446:Prospective Studies; D013290:Streptococcal Infections / Q000150:complications / Q000382:microbiology*; D013845:Thienamycins
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D002939:Ciprofloxacin; D002443:Ceftriaxone; D000077731:Meropenem
keywords: Antibiotic; ascites; cirrhosis; liver; resistance; spontaneous bacterial peritonitis