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PWE-132 A re-evaluation of epidemiology and resistance patterns of culture-positive spontaneous bacterial peritonitis in leeds
  1. L Harrison1,
  2. J Sandoe2,
  3. M Aldersley3,
  4. J Jennings1
  1. 1Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  2. 2Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
  3. 3Hepatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK

Abstract

Introduction Spontaneous bacterial peritonitis (SBP) is a frequent and serious condition with significant morbidity and mortality in patients with liver cirrhosis. Early diagnosis and prompt treatment of SBP reduces in-hospital mortality from 90% to <20%.1As a result of an audit of SBP in 2006–2008, first line antibiotic for treatment was changed to piperacillin/tazobactam and cotrimoxazole was recommended for secondary prophylaxis. The outcome of these changes was evaluated.

Method A retrospective microbiology database search was carried out on fluid samples in Leeds, a teaching hospital with liver transplantation services. The samples were obtained between December 2008 and October 2014, grew a single organism, and had an ascitic fluid neutrophil count of ≥0.25 × 109/L. Case notes were reviewed to establish a diagnosis of SBP. Resistance patterns were compared to samples received 2006–2008.

Results Of 2679 samples, 43 met criteria for single organism SBP. The mean age was 53.1 and 30/43 (70%) were men. Nine patients were Child’s Pugh Score B and 34 were Child’s Pugh Score C with a 30 day mortality of 22.2% and 56% respectively. The 30 day mortality was 48.8% (21/43) consistent with data from 2006–2008 audit.

74.4% patients had underlying alcohol related liver disease. 78.8% of organisms were Gram-negative with the majority being E coli. There was a large proportion of Gram-positive organisms which were mostly streptococci. Nine patients had prior SBP infections and twelve patients were prescribed secondary prophylaxis.

Abstract PWE-132 Table 1

Gram-negative bacteria resistance patterns

Conclusion SBP remains a poor prognostic indicator with a 48.8%, 30-day mortality. A high index of suspicion is essential and empirical antibiotic therapy should be provided.

Our results demonstrate a shift from Gram-negative to Gram-positive organisms. This is likely to be due to previous exposure to antibiotics and secondary prophylaxis.

Nationally there is an increase in multidrug-resistant Gram-negative organisms. Prior to 2010, quinolone antibiotics such as ciprofloxacin and cephalosporins were more widely used and recommended by BSG guidelines. This reaudit demonstrates a reduction in resistant organisms, especially to ciprofloxaxin. This demonstrates the importance of auditing and reviewing local antimicrobial guidelines.

Disclosure of interest None Declared.

Reference

  1. Garcia-Tsao G. Current management of the complications of cirrhosis and portal hypertension: variceal haemorrhage, ascites and spontaneous bacterial peritonitis. Gastroenterology. 2001;120:726-48

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