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Resistance to third-generation cephalosporins increased mortality risk for patients with spontaneous bacterial peritonitis

Resistance to third-generation cephalosporins, such as ceftriaxone, in treating patients with spontaneous bacterial peritonitis, is a mortality risk in community, health care, and nosocomial settings, according to study results.

Researchers conducted an observational study on a cohort of 200 patients diagnosed with cirrhosis and 246 spontaneous bacterial peritonitis (SBP) episodes with positive blood and/or ascetic culture. The study was conducted from 2001 to 2009 at a hospital in Barcelona, Spain.

Previously reported studies indicated increased infections in patients with cirrhosis because of microorganisms resistant to third-generation cephalosporins (3rdGC), the most commonly prescribed treatment for SBP episodes. The researchers’ goal was to measure the risks associated with drug resistance. In the study, patients’ SBP episodes were categorized into three groups depending on place of acquisition: community (n=85), health care (n=95), or nosocomial (n=66).

Patients in the community- (92%), health care- (84.7%), and nosocomial- (67.6%) acquired groups were treated for a median of 10 days, primarily with ceftriaxone. Overall, there were 80 deaths after 30 days of treatment (33.8%), 138 patients remained alive (58.2%), eight underwent liver transplants (3.4%), nine developed new SBP episodes (3.8%), and two were lost to follow-up (.8%). Mortality rates in the community-acquired group and the health-care related-group were similar, 28.2% and 25.8%, respectively; mortality among the nosocomial acquisition-group was significantly higher at 54.2%.

“The risk of third-generation cephalosporin resistance was particularly high in nosocomially acquired episodes of [SBP],” researchers concluded. “The extent of resistance and the adequacy of empirical antibiotics had a significant effect on mortality along with the patient’s hepato-renal function. Our results show high rates of resistance (21.5%) and are broadly in agreement with other recently reported studies.”