Changing antimicrobial sensitivity patterns in patients with spontaneous bacterial peritonitis: Can it be prevented?
Azmat Ali, Awais Saeed Abbasi.
Objective: To assess the changing patterns of antimicrobial sensitivity in patients with spontaneous bacterial peritonitis (SBP).
Methodology: Data of 69 patients having decompensated liver disease (DCLD) with ascites and SBP was analyzed from July 2014 to December 2016. The Bactec blood culture system was used. Kirby-Bauer (KB) method was used for drug sensitivity testing. Statistical Package for Social Sciences (SPSS) version 20 was used for data analysis. The clinical data of the study patients were stated as number of patients and percentages.
Results: Out of a total of 69 patients, 43 (62.4%) were males and 26 (37.6%) were females. Average age was 40.84 years. 61 (88.4%) patients were admitted in medical ward while 8 (11.6%) patients were admitted in intensive care unit (ICU). Ascitic fluid of 68 (98.5%) patients revealed growth of Escherichia Coli (E. coli) while 1 (1.4%) had growth of Klebsiella Pneumoniae. Against E. coli, Amikacin and Imipenem were the most sensitive antimicrobials having sensitivity in 100 % (n=68) cases. Pipercillin/Tazobactam was sensitive in 91.3 % (n=63) cases. Trimethoprim/Sulfamethoxazole and Cefpirome were sensitive in 88.4 % (n=61) cases. Meropenem had a sensitivity of 84 % (n=58). Cefoperazone/Sulbactam had a sensitivity of 79.7 % (n=55). Cefixime and Ceftriaxone were sensitive in 76.8 % (n=53) cases. Against Klebsiella Pneumoniae. Amikacin, Imipenem, Pipercillin/Tazobactam, Cefpirome, Meropenem, Cefoperazone/Sulbactam, Ciprofloxacin, Cefixime, and Levofloxacin had sensitivity of 100 % (n=1).
Conclusion: Escherichia Coli (E. coli) was the most abundant microorganism (98.5%) found in Ascitic fluid cultures having 100% sensitivity to Amikacin and Imipenem followed by Pipercillin/Tazobactam (91.3%). Usual antimicrobials used empirically (Cefoperazone/Sulbactam & Ceftriaxone) had sensitivity of 79.7% & 76.8%, respectively. These may no longer be the first choice of empiric therapy. Oral preparations for prophylaxis included Trimethoprim/Sulfamethoxazole (88.4%) followed by Cefixime (76.8%).
Ascites, spontaneous bacterial peritonitis, SBP, E. coli.
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