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Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice.
- Source :
-
World journal of gastroenterology [World J Gastroenterol] 2008 May 07; Vol. 14 (17), pp. 2757-62. - Publication Year :
- 2008
-
Abstract
- Aim: To verify the validity of the International Ascites Club guidelines for treatment of spontaneous bacterial peritonitis (SBP) in clinical practice.<br />Methods: All SBP episodes occurring in a group of consecutive cirrhotics were managed accordingly and included in the study. SBP was diagnosed when the ascitic fluid polymorphonuclear (PMN) cell count was > 250 cells/mm3, and empirically treated with cefotaxime.<br />Results: Thirty-eight SBP episodes occurred in 32 cirrhotics (22 men/10 women; mean age: 58.6 +/- 11.2 years). Prevalence of SBP, in our population, was 17%. Ascitic fluid culture was positive in nine (24%) cases only. Eleven episodes were nosocomial and 71% community-acquired. Treatment with cefotaxime was successful in 59% of cases, while 41% of episodes required a modification of the initial antibiotic therapy because of a less-than 25% decrease in ascitic PMN count at 48 h. Change of antibiotic therapy led to the resolution of infection in 87% of episodes. Among the cases with positive culture, the initial antibiotic therapy with cefotaxime failed at a percentage (44%) similar to that of the whole series. In these cases, the isolated organisms were either resistant or with an inherent insufficient susceptibility to cefotaxime.<br />Conclusion: In clinical practice, ascitic PMN count is a valid tool for starting a prompt antibiotic treatment and evaluating its efficacy. The initial treatment with cefotaxime failed more frequently than expected. An increase in healthcare-related infections with antibiotic-resistant pathogens may explain this finding. A different first-line antibiotic treatment should be investigated.
- Subjects :
- Aged
Ascitic Fluid microbiology
Ascitic Fluid pathology
Bacterial Infections etiology
Bacterial Infections microbiology
Bacterial Infections pathology
Drug Resistance, Bacterial
Female
Humans
Liver Cirrhosis therapy
Male
Middle Aged
Neutrophils pathology
Peritonitis etiology
Peritonitis microbiology
Peritonitis pathology
Treatment Failure
Treatment Outcome
Anti-Bacterial Agents therapeutic use
Bacterial Infections therapy
Cefotaxime therapeutic use
Liver Cirrhosis complications
Peritonitis therapy
Practice Guidelines as Topic
Subjects
Details
- Language :
- English
- ISSN :
- 1007-9327
- Volume :
- 14
- Issue :
- 17
- Database :
- MEDLINE
- Journal :
- World journal of gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 18461661
- Full Text :
- https://doi.org/10.3748/wjg.14.2757