Liver Center, Beth Israel Deaconess Medical Center, 110 Francis St, LMOB 8E, Boston, MA, 02215, USA.
Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Dig Dis Sci. 2019 Aug;64(8):2359-2367. doi: 10.1007/s10620-019-05519-4. Epub 2019 Feb 14.
There are few studies addressing the impact of cephalosporin and quinolone resistance on hospital length of stay and mortality in spontaneous bacterial peritonitis (SBP). We aim to describe the shifting epidemiology of SBP at our institution and its impact on clinical outcomes.
We performed a single-center retrospective cohort study of all cases of SBP from 2005 to 2015 at a transplant center. Cases were identified using hospital billing data. Patient data were confirmed using the electronic medical record. Univariate and multivariate logistic regression and Cox proportional hazards models were used to identify factors that were associated with prolonged hospital length of stay and reduced survival. Culture-positive cases (N = 56) were compared to culture-negative cases (N = 104). Subpopulation analysis of the culture-positive cases compared ceftriaxone-resistant (N = 25) to ceftriaxone-susceptible (N = 31) cases.
We identified 160 cases of SBP (56 culture positive and 104 culture negative; 21 nosocomial, 79 hospital associated, and 60 community acquired). Forty-five percent (N = 25 total, 13 hospital associated and 6 nosocomial) of bacterial isolates were resistant to ceftriaxone, with 37.5% (N = 21) being gram positive, including 8 methicillin-resistant staphylococcus and 6 vancomycin-resistant enterococcus. Multivariate analysis identified hospital-associated SBP, age, alcoholic cirrhosis, and MELD-Na score as variables associated with worse survival (P < 0.05), with a trend toward worse survival in culture-positive cases (P = 0.123). Only MELD-Na was associated with prolonged length of stay.
The burden of resistant pathogens causing SBP is significant, notably in hospital-associated SBP. Culture-positive SBP may represent a higher risk group compared to culture-negative SBP.
关于头孢菌素和喹诺酮耐药性对自发性细菌性腹膜炎（SBP）住院时间和死亡率的影响，研究甚少。我们旨在描述我院 SBP 的不断变化的流行病学及其对临床结果的影响。
我们对一家移植中心 2005 年至 2015 年所有 SBP 病例进行了单中心回顾性队列研究。使用医院计费数据识别病例。使用电子病历确认患者数据。使用单变量和多变量逻辑回归和 Cox 比例风险模型确定与住院时间延长和生存率降低相关的因素。将培养阳性病例（N=56）与培养阴性病例（N=104）进行比较。对培养阳性病例的亚组分析比较了头孢曲松耐药（N=25）与头孢曲松敏感（N=31）病例。
我们确定了 160 例 SBP（56 例培养阳性和 104 例培养阴性；21 例院内，79 例医院相关，60 例社区获得性）。56%的细菌分离株（N=25，包括 13 例医院相关和 6 例院内）对头孢曲松耐药，其中 37.5%（N=21）为革兰阳性菌，包括 8 株耐甲氧西林金黄色葡萄球菌和 6 株耐万古霉素肠球菌。多变量分析确定医院相关的 SBP、年龄、酒精性肝硬化和 MELD-Na 评分是与生存率较差相关的变量（P<0.05），而培养阳性病例的生存率有下降趋势（P=0.123）。只有 MELD-Na 与住院时间延长相关。
导致 SBP 的耐药病原体负担很大，尤其是在医院相关的 SBP 中。与培养阴性 SBP 相比，培养阳性 SBP 可能代表一个更高的风险群体。
