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Clinical impact of healthcare-associated acquisition in cirrhotic patients with community-onset spontaneous bacterial peritonitis

Korean Journal of Internal Medicine 2020년 35권 1호 p.215 ~ 221
김정옥 ( Kim Jung-Ok ) - Chungnam National University School of Medicine Department of Internal Medicine

강철인 ( Kang Cheol-In ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
곽금연 ( Gwak Geum-Youn ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
정두련 ( Chung Doo-Ryeon ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
백경란 ( Peck Kyong-Ran ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
송재훈 ( Song Jae-Hoon ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine

Abstract


Background/Aims: Healthcare-associated (HCA) infection is a recently suggested new category of community-onset infections. The implications of HCA infections in terms of diagnosis, treatment, and outcomes of spontaneous bacterial peritonitis (SBP) are not well understood. We sought to delineate the differences between community-acquired (CA) SBP and HCA SBP with specific interest in the antimicrobial resistance of causative microorganisms and outcomes.

Methods: We conducted a retrospective cohort study of all SBP episodes with positive ascitic culture and/or blood culture from June 2000 to August 2011. Community-onset SBP episodes were included when they occurred within 48 hours after admission and were classified as CA SBP and HCA SBP based on the predefined criteria.

Results: A total of 188 episodes of community-onset SBP were analyzed (65.4% HCA SBP and 34.6% CA SBP). HCA SBP had a higher resistance rate to third-generation cephalosporin (6.8% vs. 1.6%, p = 0.168). The overall 30-day mortality was similar between both groups (37.4% vs. 41.5%, p = 0.638). The independent risk factors for 30-day all-cause mortality in community-onset SBP included high Child-Pugh score, acute kidney injury, and resistance to third-generation cephalosporins; HCA infection was not associated.

Conclusions: Hepatic functional status, renal dysfunction, and third-generation cephalosporin resistant pathogens more adversely affected the outcome of cirrhotic patients with community-onset SBP rather than HCA infection. The higher rate of third-generation cephalosporin resistance was notable in HCA SBP, which will require a novel approach to empirical antibiotic treatment selection in this population.

키워드

Spontaneous bacterial peritonitis; Liver cirrhosis; Mortality
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