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Cephalosporin resistance in community acquired spontaneous bacterial peritonitis

OBJECTIVE: To determine 3(rd) generation cephalosporin resistance in patients with community-acquired spontaneous bacterial peritonitis (SBP) using early response assessment. METHODS: This prospective quasi-experimental study was carried out at Doctors Hospital & Medical Center from January 2016...

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Autores principales: Sarwar, Shahid, Tarique, Shandana, Waris, Umaima, Khan, Anwaar A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Professional Medical Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408669/
https://www.ncbi.nlm.nih.gov/pubmed/30881387
http://dx.doi.org/10.12669/pjms.35.1.17
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author Sarwar, Shahid
Tarique, Shandana
Waris, Umaima
Khan, Anwaar A.
author_facet Sarwar, Shahid
Tarique, Shandana
Waris, Umaima
Khan, Anwaar A.
author_sort Sarwar, Shahid
collection PubMed
description OBJECTIVE: To determine 3(rd) generation cephalosporin resistance in patients with community-acquired spontaneous bacterial peritonitis (SBP) using early response assessment. METHODS: This prospective quasi-experimental study was carried out at Doctors Hospital & Medical Center from January 2016 to September 2018. Patients with cirrhosis and SBP were included. Third generation cephalosporins i.e. cefotaxime/ceftriaxone were used for treatment of SBP. Response after 48 hours was assessed and decline in ascitic fluid neutrophil count of < 25% of baseline was labelled as cephalosporin resistant. Carbapenem were used as second line treatment. Recovery and discharge or death of patients were primary end points. RESULTS: Male to female ratio in 31 patients of SBP was 1.2/1 (17/14). Hepato-renal syndrome was diagnosed in 11(37.9%) patients. Cefotaxime was used for 16(51.6%) patients whereas ceftriaxone for 15(48.3%) patients. Early response of SBP was noted in 26(83.8%) patients while 5 (16.2%) were non-responders to cephalosporins. SBP resolved in all non-responding patients with i/v carbapenem. In-hospital mortality was 12.9% and had no association with cephalosporin resistance. High bilirubin (p 0.04), deranged INR (p 0.008), low albumin (p 0.04), high Child Pugh (CTP) score (p 0.03) and MELD scores (p 0.009) were associated with in-hospital mortality. CONCLUSION: Cephalosporin resistance was present in 16.2% of study patients with community-acquired SBP. Mortality in SBP patients is associated with advanced stage of liver disease.
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spelling pubmed-64086692019-03-15 Cephalosporin resistance in community acquired spontaneous bacterial peritonitis Sarwar, Shahid Tarique, Shandana Waris, Umaima Khan, Anwaar A. Pak J Med Sci Original Article OBJECTIVE: To determine 3(rd) generation cephalosporin resistance in patients with community-acquired spontaneous bacterial peritonitis (SBP) using early response assessment. METHODS: This prospective quasi-experimental study was carried out at Doctors Hospital & Medical Center from January 2016 to September 2018. Patients with cirrhosis and SBP were included. Third generation cephalosporins i.e. cefotaxime/ceftriaxone were used for treatment of SBP. Response after 48 hours was assessed and decline in ascitic fluid neutrophil count of < 25% of baseline was labelled as cephalosporin resistant. Carbapenem were used as second line treatment. Recovery and discharge or death of patients were primary end points. RESULTS: Male to female ratio in 31 patients of SBP was 1.2/1 (17/14). Hepato-renal syndrome was diagnosed in 11(37.9%) patients. Cefotaxime was used for 16(51.6%) patients whereas ceftriaxone for 15(48.3%) patients. Early response of SBP was noted in 26(83.8%) patients while 5 (16.2%) were non-responders to cephalosporins. SBP resolved in all non-responding patients with i/v carbapenem. In-hospital mortality was 12.9% and had no association with cephalosporin resistance. High bilirubin (p 0.04), deranged INR (p 0.008), low albumin (p 0.04), high Child Pugh (CTP) score (p 0.03) and MELD scores (p 0.009) were associated with in-hospital mortality. CONCLUSION: Cephalosporin resistance was present in 16.2% of study patients with community-acquired SBP. Mortality in SBP patients is associated with advanced stage of liver disease. Professional Medical Publications 2019 /pmc/articles/PMC6408669/ /pubmed/30881387 http://dx.doi.org/10.12669/pjms.35.1.17 Text en Copyright: © Pakistan Journal of Medical Sciences http://creativecommons.org/licenses/by/3.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Sarwar, Shahid
Tarique, Shandana
Waris, Umaima
Khan, Anwaar A.
Cephalosporin resistance in community acquired spontaneous bacterial peritonitis
title Cephalosporin resistance in community acquired spontaneous bacterial peritonitis
title_full Cephalosporin resistance in community acquired spontaneous bacterial peritonitis
title_fullStr Cephalosporin resistance in community acquired spontaneous bacterial peritonitis
title_full_unstemmed Cephalosporin resistance in community acquired spontaneous bacterial peritonitis
title_short Cephalosporin resistance in community acquired spontaneous bacterial peritonitis
title_sort cephalosporin resistance in community acquired spontaneous bacterial peritonitis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408669/
https://www.ncbi.nlm.nih.gov/pubmed/30881387
http://dx.doi.org/10.12669/pjms.35.1.17
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