Published online Jul 7, 2017. doi: 10.3748/wjg.v23.i25.4654
Peer-review started: December 30, 2016
First decision: March 16, 2017
Revised: March 31, 2017
Accepted: June 19, 2017
Article in press: June 19, 2017
Published online: July 7, 2017
Processing time: 190 Days and 4.6 Hours
To systematically review literature upon aetiology of nosocomial spontaneous bacterial peritonitis (N-SBP) given the rising importance of multidrug-resistant (MDR) bacteria.
A literature search was performed on MEDLINE and Google Scholar databases from 2000 to 15th of November 2016, using the following search strategy: “spontaneous” AND “peritonitis”.
The initial search through electronic databases retrieved 2556 records. After removing duplicates, 1958 records remained. One thousand seven hundred and thirty-five of them were excluded on the basis of the screening of titles and abstract, and the ensuing number of remaining articles was 223. Of these records, after careful evaluation, only 9 were included in the qualitative analysis. The overall proportion of MDR bacteria turned out to be from 22% to 73% of cases across the studies.
N-SBP is caused, in a remarkable proportion, by MDR pathogens. This should prompt a careful re-assessment of guidelines addressing the treatment of this clinical entity.
Core tip: Nosocomial spontaneous bacterial peritonitis (N-SBP) develops in up to one-third of cirrhotic patients. The overall 30-d survival for N-SBP is only 20%, also due to an inadequate empirical antibiotic therapy (EAT). The aim of our Sistematic Review is to describe N-SBP bacterial aetiology and the prevalence of multiple drug resistance (MDR) pathogens to suggest which EAT may be adequate in these entities. After careful evaluation 9 studies were identified. The overall proportion of MDR bacteria was up to 22%-73% of cases. EAT with a carbapenem plus daptomycin and a Beta-lactam active against methicillin-resistant cocci should be considered in centers with a high prevalence of MDR bacteria.