Title: Factors Predicting Failure of 3rd Generation Cephalosporins in Treatment of Spontaneous Bacterial Peritonitis- A Retrospective Observational Study
Authors: Ramu Muraleedharanpillai, Gopu R Babu, Srijaya Sreesh, Krishnadas Devadas
DOI: https://dx.doi.org/10.18535/jmscr/v5i8.49
Abstract
Background: Spontaneous bacterial peritonitis (SBP) is the most prevalent bacterial infection in patients with cirrhosis. Cefotaxim has been considered the first choice of empirical antibiotic for the treatment of SBP. Studies from different parts of world have reported significant rates of resistance to third-generation cephalosporins. Patients not responding to 3rd generation cephalosporins require longer duration of treatment with higher spectrum antibiotics which will prolong the hospital stay and more financial constrains for the patients
Objective: To find Factors predicting failure of 3rd generation cephalosporins in treatment of SBP in decompensated cirrhosis patients
Methods: Retrospective Observational study by data collection of all patients admitted with cirrhosis and SBP who were started on cefotaxim from januvary 2015 to januvary 2016 in department of medical gastroenterology govt medical college Trivandrum were done. Multivariate logistic regression was used to determine independent predictors of third-generation cephalosporin resistance
Results: 168 patients met the criteria for study inclusion. 120 (71.42%) patients responded to cephalosporin therapy. 48 (28.57%) were non responders. Alcoholic liver disease 113(67%), NASH 36 (21%), Hep B infection 26 (15%) were predominant cause of decompensated cirrhosis. 58(48.3%) responders and 22 (44%) non responders were on norflox prophylaxis. H/o recent broad spectrum antibiotic usage was found in 24 (20%) responders and 17(35.41%) non responders. On multivariate analysis MELD >19 p0.001, OR 4.37 (95% CI 2.12-9.00), presence of hepatic encephalopathy p0.014, OR 2.53 (95% CI 1.2-5.3) and recent antibiotic usage p 0.01, OR 2.44 (95% CI 1.365-5.854) emerged as significant risk factor for resistance to 3rd generation cephalosporins
Conclusion: High MELD score, presence of encephalopthy and recent broad spectrum antibiotic usage emerged as significant risk factor for resistance to 3rd generation cephalosporins. These group of patients with SBP should receive empirical treatment with higher antibiotics during admission
Keywords: SBP, Cefotaxim, Response.
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