Department of Gastroenterology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India.
Department of Gastroenterology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India.
Arab J Gastroenterol. 2024 Nov;25(4):345-348. doi: 10.1016/j.ajg.2024.09.004. Epub 2024 Oct 26.
Secondary prophylaxis with norfloxacin reduces recurrence of spontaneous bacterial peritonitis (SBP) significantly. No data available from Asia-Pacific region about recurrence of SBP in these patients.
In a retrospective cohort study, we assessed recurrence rate of SBP in patients on norfloxacin secondary prophylaxis. One year recurrence of SBP, its profile, response rate and risk factors for recurrence were assessed.
A total of 112 patients were analysed. During first episode of SBP, culture positive rate was 39/112(34.8 %) and resistance to ceftriaxone was 51.2 %. Overall efficacy of ceftriaxone as first line antibiotic was 70.5 % (70/112), but only 49 % (19/39) among culture positive patients. E. coli is the commonest organism isolated (21/39, 53.8 %), MDR organism in 12.8 % (5/39). Cumulative incidence of SPB recurrence was 22.3 % (25/112) on norfloxacin secondary prophylaxis at 1 year. Culture positive rate in recurrent SBP was 48 % (12/25) and ceftriaxone resistance and MDR organism were seen in 66.6 % and 16.6 %. Overall response rate to ceftriaxone in recurrent SBP was 40 % (10/25) and 21 % (3/14) in culture positive patients. Risk factors for SBP recurrence were age, INR and albumin (p < 0.05). No increase cumulative incidence of death among patients with or without recurrence.
Despite recent changes in bacteriological profile in SBP, recurrence of SBP on norfloxacin prophylaxis remains low. In recurrent SBP, response to ceftriaxone is significantly lower than first episode and there is trend towards increase in MDR organism in culture positive patient receiving norfloxacin.
诺氟沙星的二级预防可显著降低自发性细菌性腹膜炎（SBP）的复发率。目前尚无亚太地区患者的 SBP 复发数据。
我们在一项回顾性队列研究中评估了接受诺氟沙星二级预防的患者 SBP 复发率。评估了 SBP 的一年复发率、复发特征、反应率以及复发的危险因素。
共分析了 112 例患者。首次 SBP 发作时，培养阳性率为 39/112（34.8%），对头孢曲松的耐药率为 51.2%。头孢曲松作为一线抗生素的总体疗效为 70.5%（70/112），但在培养阳性患者中仅为 49%（19/39）。最常见的分离菌是大肠杆菌（21/39，53.8%），12.8%（5/39）为多药耐药菌。在诺氟沙星二级预防 1 年后，SBP 复发的累积发生率为 22.3%（25/112）。复发性 SBP 的培养阳性率为 48%（12/25），头孢曲松耐药和多药耐药菌分别为 66.6%和 16.6%。复发性 SBP 对头孢曲松的总体反应率为 40%（10/25），而培养阳性患者为 21%（3/14）。SBP 复发的危险因素是年龄、INR 和白蛋白（p<0.05）。在有或没有复发的患者中，死亡的累积发生率没有增加。
尽管 SBP 的细菌学特征最近发生了变化，但诺氟沙星预防后的 SBP 复发率仍然较低。在复发性 SBP 中，头孢曲松的反应率明显低于首次发作，且接受诺氟沙星治疗的培养阳性患者中多药耐药菌有增加趋势。
