Spontaneous bacterial peritonitis due to carbapenemase-producing Enterobacteriaceae: Etiology and antibiotic treatment

doi:10.4254/wjh.v12.i12.1136

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World Journal of Hepatology

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World J Hepatol. Dec 27, 2020; 12(12): 1136-1147
Published online Dec 27, 2020. doi: 10.4254/wjh.v12.i12.1136

Spontaneous bacterial peritonitis due to carbapenemase-producing Enterobacteriaceae: Etiology and antibiotic treatment

Marco Fiore, Sveva Di Franco, Aniello Alfieri, Maria Beatrice Passavanti, Maria Caterina Pace, Stephen Petrou, Francesca Martora, Sebastiano Leone

Marco Fiore, Sveva Di Franco, Aniello Alfieri, Maria Beatrice Passavanti, Maria Caterina Pace, Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy

Stephen Petrou, Department of Emergency Medicine, Good Samaritan Hospital Medical Center, NY 11795, United States

Francesca Martora, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy

Sebastiano Leone, Division of Infectious Diseases, “San Giuseppe Moscati” Hospital, Avellino 83100, Italy

Author contributions: This review was mainly written by Di Franco S; Alfieri A and Fiore M; Di Franco S and Alfieri A collected the data; Passavanti MB and Pace MC supervised the writing of the paper; Petrou S, Martora F and Leone S critically revised the paper; All authors approved the final version to be published.

Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.

Corresponding author: Marco Fiore, MD, Academic Fellow, Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Piazza Miraglia 2, Naples 80138, Italy. marco.fiore@unicampania.it

Received: June 29, 2020
Peer-review started: June 29, 2020
First decision: September 24, 2020
Revised: October 8, 2020
Accepted: October 23, 2020
Article in press: October 23, 2020
Published online: December 27, 2020
Processing time: 171 Days and 17.7 Hours

Abstract

Carbapenem antibiotics were first introduced in the 1980s and have long been considered the most active agents for the treatment of multidrug-resistant gram-negative bacteria. Over the last decade, carbapenem-resistant Enterobacteriaceae (CRE) have emerged as organisms causing spontaneous bacterial peritonitis. Infections caused by CRE have shown a higher mortality rate than those caused by bacteria sensitive to carbapenem antibiotics. Current antibiotic guidelines for the treatment of spontaneous bacterial peritonitis are insufficient, and rapid de-escalation of empiric antibiotic treatment is not widely recognized. This review summarizes the molecular characteristics, epidemiology and possible treatment of spontaneous bacterial peritonitis caused by CRE.

Keywords: Spontaneous bacterial peritonitis; Carbapenem-resistant Enterobacteriaceae; Carbapenem-resistant Klebsiella pneumoniae; Cirrhosis

Core Tip: Carbapenem antibiotics were first introduced in the 1980s and have long been considered the most active agents for the treatment of multidrug-resistant gram-negative bacteria. Over the last decade carbapenem-resistant Enterobacteriaceae (CRE) have emerged as organisms causing spontaneous bacterial peritonitis (SBP). Infections caused by CRE have shown a higher mortality rate than those caused by bacteria sensitive to carbapenem antibiotics. Current antibiotic guidelines for the treatment of SBP are insufficient, and rapid de-escalation of empiric antibiotic treatment is not widely recognized. This review summarizes the molecular characteristics, epidemiology and possible treatment of SBP caused by CRE.