Editorial
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World J Gastroenterol. Oct 21, 2014; 20(39): 14079-14086
Published online Oct 21, 2014. doi: 10.3748/wjg.v20.i39.14079
Multi-resistant bacteria in spontaneous bacterial peritonitis: A new step in management?
Angelo Alves de Mattos, Ane Micheli Costabeber, Livia Caprara Lionço, Cristiane Valle Tovo
Angelo Alves de Mattos, Ane Micheli Costabeber, Livia Caprara Lionço, Cristiane Valle Tovo, Department of Gastroenterology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90430-080, Brasil
Author contributions: Mattos AA conceptualized and designed this editorial; Lionço LC and Costabeber AM reviewed the literature and wrote the manuscript; Mattos AA and Tovo CV reviewed the manuscript critically for important intellectual content; all authors approved the final version of the manuscript.
Correspondence to: Cristiane Valle Tovo, MD, PhD, Department of Gastroenterology, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Cel Aurélio Bitencourt 115, Apt. 201, Porto Alegre 90430-080, Brasil. cris.tovo@terra.com.br
Telephone: +55-51-32148158 Fax: +55-51-32148158
Received: March 25, 2014
Revised: May 4, 2014
Accepted: June 26, 2014
Published online: October 21, 2014
Processing time: 209 Days and 9.5 Hours
Abstract

Spontaneous bacterial peritonitis (SBP) is the most typical infection observed in cirrhosis patients. SBP is responsible for an in-hospital mortality rate of approximately 32%. Recently, pattern changes in the bacterial flora of cirrhosis patients have been observed, and an increase in the prevalence of infections caused by multi-resistant bacteria has been noted. The wide-scale use of quinolones in the prophylaxis of SBP has promoted flora modifications and resulted in the development of bacterial resistance. The efficacy of traditionally recommended therapy has been low in nosocomial infections (up to 40%), and multi-resistance has been observed in up to 22% of isolated germs in nosocomial SBP. For this reason, the use of a broad empirical spectrum antibiotic has been suggested in these situations. The distinction between community-acquired infectious episodes, healthcare-associated infections, or nosocomial infections, and the identification of risk factors for multi-resistant germs can aid in the decision-making process regarding the empirical choice of antibiotic therapy. Broad-spectrum antimicrobial agents, such as carbapenems with or without glycopeptides or piperacillin-tazobactam, should be considered for the initial treatment not only of nosocomial infections but also of healthcare-associated infections when the risk factors or severity signs for multi-resistant bacteria are apparent. The use of cephalosporins should be restricted to community-acquired infections.

Keywords: Spontaneous peritonitis; Multi-resistant bacteria; Cirrhosis; Infection; Ascites

Core tip: Spontaneous bacterial peritonitis (SBP) is the most typical infection observed in cirrhosis patients. The increasing trend of bacterial resistance development in cirrhotic patients with SBP has been associated with a low treatment efficacy of traditional therapy in nosocomial infections. The use of a broad empirical spectrum antibiotic has been suggested as an alternative. Cephalosporin use should be restricted to community-acquired infections, while changes are necessary with regard to empiric therapy recommendations. Broad-spectrum antimicrobial agents, such as carbapenems with or without glycopeptides or piperacillin-tazobactam, should be considered for the initial treatment of nosocomial infections.