P-14 SPONTANEOUS BACTERIAL PERITONITIS IN CIRRHOTIC PATIENTS: PREVALENCE AND ANTIBIOTIC RESISTANCE PATTERNS

• Published in: Annals of hepatology 2024-02, Vol.29, p.101201, Article 101201
• Main Authors: Campos, Bruno, Silva, Eliabe, Lopes, Guilherme Grossi, De Oliveira, Guilherme, Rocha, Joao Pedro, Cunha, Júlia, Normando, Laura, Melo, Laura, Menezes, Laura Carolina, Costa, Luciana, Alves, Cláudia
• Format: Article
• Language: English
• ISSN: 1665-2681; 2659-5982
• DOI: 10.1016/j.aohep.2023.101201

Spontaneous bacterial peritonitis (SBP) is a leading cause of mortality in cirrhotic patients, and antibiotic resistance poses a significant challenge. This study aimed to assess the prevalence of SBP and the microbial patterns found in peritoneal fluid among hospitalized patients with cirrhosis. All patients with decompensated cirrhosis, aged 18 years or older, who underwent propaedeutic paracentesis between 01/01/2017 and 13/09/2021 at a Brazilian university hospital, were included in the study. A total of 366 individuals were enrolled [(65.6% male; median age 61 (53-68) years]. The primary causes of cirrhosis were ethanolic (43.7%) and viral hepatitis (24.8%). SBP was diagnosed in 118 patients (18.6%). Only 16.1% of all patients received antibiotic prophylaxis, with norfloxacin being the preferred choice for 78% of them. Among the 34 peritoneal fluid samples with bacterial growth, 58 microorganisms were isolated. These included 50% classified as multi-sensitive (MS), 40% as multidrug-resistant (MDR), and 10% as extensively drug-resistant (XDR) bacteria. Gram-negative bacteria accounted for 62% of the isolates, while gram-positive bacteria made up 38%. The most frequently identified microorganisms were Escherichia coli for gram-negatives and the Staphylococcus ssp. for gram-positives. Meropenem demonstrated the highest overall sensitivity (79%), followed by piperacillin/tazobactam (67%). Conversely, ceftriaxone (48%) and ciprofloxacin (41%) exhibited the highest rates of resistance. Antibiotic prophylaxis did not influence resistance rates and no XDR bacteria were isolated from patients exposed to norfloxacin. Our findings indicate that half of the SBP patients present with MDR or XDR bacteria. Empirical therapies such as meropenem and piperacillin/tazobactam show the greatest effectiveness. Additionally, antibiotic prophylaxis was not associated with an increase in antimicrobial resistance.