Aim: To verify the validity of the International Ascites Club guidelines for treatment of spontaneous bacterial peritonitis (SBP) in clinical practice. 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 cell/mm3, and empirically treated with cefotaxime. 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. 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. © 2008 WJG. All rights reserved.

Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice / Stefania, Angeloni; Cinzia, Leboffe; Alessandra, Parente; Venditti, Mario; Alessandra, Giordano; Merli, Manuela; Riggio, Oliviero. - In: WORLD JOURNAL OF GASTROENTEROLOGY. - ISSN 1007-9327. - STAMPA. - 14:17(2008), pp. 2757-2762. [10.3748/wjg.14.2757]

Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice

VENDITTI, Mario;MERLI, Manuela;RIGGIO, Oliviero
2008

Abstract

Aim: To verify the validity of the International Ascites Club guidelines for treatment of spontaneous bacterial peritonitis (SBP) in clinical practice. 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 cell/mm3, and empirically treated with cefotaxime. 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. 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. © 2008 WJG. All rights reserved.
2008
antibiotic-resistant pathogens; cefotaxime; ascitic polymorphonuclear count; spontaneous bacterial peritonitis; cirrhosis
01 Pubblicazione su rivista::01a Articolo in rivista
Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice / Stefania, Angeloni; Cinzia, Leboffe; Alessandra, Parente; Venditti, Mario; Alessandra, Giordano; Merli, Manuela; Riggio, Oliviero. - In: WORLD JOURNAL OF GASTROENTEROLOGY. - ISSN 1007-9327. - STAMPA. - 14:17(2008), pp. 2757-2762. [10.3748/wjg.14.2757]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/365849
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