Authors: A Umgelter W Reindl M Miedaner R M Schmid W Huber
Publish Date: 2009/01/23
Volume: 37, Issue: 1, Pages: 2-
Abstract
Increases in Grampositive infections and infections with Enterobacteriaceae with antimicrobial resistance have been reported in patients with spontaneous bacterial peritonitis SBP This study was performed to investigate the rate of treatment failures of recommended empirical therapies and the impact on mortality17 patients initially received a broader than recommended antibiotic regimen Most of these were treated in the intensive care unit because of severe sepsis/septic shock Hospital mortality in this group was 82 A modification of therapy was necessary in 24 of the 84 patients receiving one of the published firstline therapies cefotaxime ampicillin/clavulanate or ciprofloxacin Mortality was significantly higher in these patients than in those with no change in treatment 667 vs 30 p = 0002 In 29 patients with positive cultures mortality was also higher in those with an ineffective firstline treatment 90 vs 45 p = 0032 In the multivariable analysis a modification of antibiotic treatment was an independent risk factor for mortality odds ratio 5876 95 confidence interval 1826–18910 p = 0003 In 41 culturepositive cases the most commonly cultured pathogens were Escherichia coli n = 17 and Enterococcus faecium n = 10 Of the encountered bacterial microorganisms 14 333 were resistant to cefotaxime 17 386 were resistant to amoxicillin/clavulanate and 19 452 were resistant to ciprofloxacin 29 644 of the isolates were resistant to one of the recommended firstline antibiotic regimens and 11 244 of the isolates were resistant to all three
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