Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany.
University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany.
Clin Infect Dis. 2020 Apr 15;70(9):1916-1924. doi: 10.1093/cid/ciz540.
The efficacy of antibiotic prophylaxis to prevent spontaneous bacterial peritonitis (SBP) in patients colonized with multidrug-resistant organisms (MDROs) is unknown. We evaluated the effectiveness of fluoroquinolone-based SBP prophylaxis in an era and area of frequent antibiotic resistance.
This is a prospective observational study in patients with liver cirrhosis and an indication for fluoroquinolone-based prophylaxis of SBP. Patients were recruited and followed in a large German tertiary reference center with comprehensive microbiological and clinical monitoring performed at baseline and after 30, 60, 90, and 180 days of prophylaxis.
Overall, 77 patients received antibiotic prophylaxis for an average of 93 days. Baseline prevalence of colonization with MDROs was high (N = 39, 50.6%). At least one de novo MDRO was detected in 27 patients (35.1%) during antibiotic prophylaxis; 33 patients (42.9%) developed secondary infections, including 14 cases (17.9%) of infections with MDROs, and 13 cases (16.9%) of de novo/recurrent SBP. Thirty patients (39.0%) died during follow-up. Significantly higher risks of SBP development during antibiotic prophylaxis were observed for patients with versus without any apparent MDROs (P = .009), vancomycin-resistant enterococci (P = .008), multidrug-resistant gram-negative bacteria (P = .016), or quinolone-resistant gram-negative bacteria (QR-GNB) (P = .015). In competing risk analysis, QR-GNB were independently associated with prophylaxis failure (hazard ratio, 3.39; P = .045) and infections with QR-GNB were independently associated with death before SBP (subdistribution hazard risk, 6.47; P = .034).
Antibiotic prophylaxis of SBP appears to be less efficient in patients with known MDROs. Regular MDRO screening seems to be useful to tailor treatment of secondary infections and re-evaluate antibiotic prophylaxis in case of selection of quinolone resistance.
对于多重耐药菌（MDRO）定植的患者，抗生素预防能否有效预防自发性细菌性腹膜炎（SBP）尚不清楚。我们评估了氟喹诺酮类药物预防 SBP 在一个抗生素耐药频繁的时代和地区的有效性。
这是一项在德国一家大型三级参考中心进行的前瞻性观察性研究，对有 SBP 氟喹诺酮类药物预防指征的肝硬化患者进行招募和随访。在基线和预防后 30、60、90 和 180 天进行全面的微生物学和临床监测。
共有 77 名患者接受了平均 93 天的抗生素预防。MDRO 定植的基线患病率很高（N = 39，50.6%）。在抗生素预防期间，至少有 27 名患者（35.1%）检测到新发 MDRO；33 名患者（42.9%）发生了继发性感染，包括 14 例（17.9%）MDRO 感染和 13 例（16.9%）新发/复发性 SBP。30 名患者（39.0%）在随访期间死亡。与无明显 MDRO 患者相比，有任何明显 MDRO（P =.009）、耐万古霉素肠球菌（P =.008）、多重耐药革兰氏阴性菌（P =.016）或氟喹诺酮类耐药革兰氏阴性菌（QR-GNB）（P =.015）的患者发生 SBP 的风险显著更高。在竞争风险分析中，QR-GNB 与预防失败独立相关（危险比，3.39；P =.045），QR-GNB 感染与 SBP 前死亡独立相关（亚分布危险比，6.47；P =.034）。
对于已知 MDRO 的患者，抗生素预防 SBP 的效果似乎较差。定期进行 MDRO 筛查似乎有助于针对继发性感染进行治疗，并在选择喹诺酮耐药时重新评估抗生素预防。
