Background and aim: Spontaneous bacterial peritonitis (PBE) and bacterioascitis are frequent complications in cirrhotic patients with ascites. Treatment guidelines recommend third-generation cephalosporins (C3G) as the first choice, however, antimicrobial resistance in our setting is unknown. The objective of the study was to know the microbiological and resistance profile associated with PBE and bacterioascitis in our population.
Material and methods: Retrospective study, which included results from ascites fluid culture between May 2017 to May 2020. Adults with a diagnosis of PBE (> 250 PMN cel / ml3 and a positive culture) or with a diagnosis of bacterioascitis (positive culture with <250 PMN cel / ml3) were included. Incomplete records or non-cirrhotic ascites were excluded. Variables: sex, age, etiology, treatment, and bacteriology results. The analysis was descriptive.
Results: Of 242 files, 214 (88.4%) were included. 84 women (39.2%) and 130 men (60.7%); average age 61 years (range 26-91). 26/214 (12.1%) with PBE and 16/214 (7.4%) bacterioascitis. 42/214 (19.6%) cultures were positive, of these 26/42 (61.9%) had PBE and 16/42 (38.0%) bacterioascitis. The pathogens isolated in descending order were: E. Coli 21 (50%, 11/21 BLEE), S maltophila 5 (11.9%), Staphylococcus 4 (9.5%), Sphingomonas 2 (4.7%), Klebsiella 2 (4.7%), Candida 2 (4.7%), Enterococcus 2 (4.7%), Streptococcus 2 (4.7%), L. inocua 1 (2.3%), C. neoformans 1 (2.3%). The results of the antibiogram highlighted: resistance to Cs3G in 30.9% (13/42), to quinolones in 33.3% (14/42), carbapenems in 3/42 (7.1%) and to piperacillin / tazobactam in 1/42 (2.3%).
Conclusions: The positivity of the culture was low. The most frequent causal agent was E. Coli, similar to that reported in the literature. Rare isolated pathogens such as S. Maltophila and fungi can translate intense immunosuppression and multiple previous antibiotic exposures in this population. We found high resistance to antimicrobial groups commonly used in hospital such as cephalosporins and quinolones. Undoubtedly, the antimicrobial scheme must be adapted locally and dynamically according to microbiology results, in order to optimize the outcome in these cases.
Conflicts of interest: The authors have no conflicts of interest to declare.
