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Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 7, 2008; 14(17): 2757-2762
Published online May 7, 2008. doi: 10.3748/wjg.14.2757
Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice
Stefania Angeloni, Cinzia Leboffe, Antonella Parente, Mario Venditti, Alessandra Giordano, Manuela Merli, Oliviero Riggio
Stefania Angeloni, Cinzia Leboffe, Antonella Parente, Mario Venditti, Manuela Merli, Oliviero Riggio, Department of Clinical Medicine, “Sapienza” University of Rome, Roma 00185, Italy
Alessandra Giordano, Department of Public Health, “Sapienza” University of Rome, Rome 00185, Italy
Author contributions: Angeloni S, Leboffe C, Venditti M and Parente A enrolled/followed the patients and collected and analysed the data; Giordano A performed bacteriological examinations; Angeloni S, Merli M and Riggio O designed the study and wrote the paper.
Correspondence to: Oliviero Riggio, MD, Department of Clinical Medicine, “Sapienza” University of Rome, Viale dell’Università 37, Roma 00185, Italy. oliviero.riggio@uniroma1.it
Telephone: +39-64-9972001
Fax: +39-64-9972001
Received: January 9, 2008
Revised: March 26, 2008
Published online: May 7, 2008

AIM: To verify the validity of the International Ascites Club guidelines for treatment of spontaneous bacterial peritonitis (SBP) in clinical practice.

METHODS: All SBP episodes occurring in a group of consecutive cirrhotics were managed accordingly and included in the study. SBP was diagnosed when the ascitic fluid polymorphonuclear (PMN) cell count was > 250 cells/mm3, and empirically treated with cefotaxime.

RESULTS: Thirty-eight SBP episodes occurred in 32 cirrhotics (22 men/10 women; mean age: 58.6 ± 11.2 years). Prevalence of SBP, in our population, was 17%. Ascitic fluid culture was positive in nine (24%) cases only. Eleven episodes were nosocomial and 71% community-acquired. Treatment with cefotaxime was successful in 59% of cases, while 41% of episodes required a modification of the initial antibiotic therapy because of a less-than 25% decrease in ascitic PMN count at 48 h. Change of antibiotic therapy led to the resolution of infection in 87% of episodes. Among the cases with positive culture, the initial antibiotic therapy with cefotaxime failed at a percentage (44%) similar to that of the whole series. In these cases, the isolated organisms were either resistant or with an inherent insufficient susceptibility to cefotaxime.

CONCLUSION: In clinical practice, ascitic PMN count is a valid tool for starting a prompt antibiotic treatment and evaluating its efficacy. The initial treatment with cefotaxime failed more frequently than expected. An increase in healthcare-related infections with antibiotic-resistant pathogens may explain this finding. A different first-line antibiotic treatment should be investigated.

Keywords: Spontaneous bacterial peritonitis, Cefotaxime, Antibiotic-resistant pathogens, Ascitic polymorphonuclear count, Cirrhosis