374. Who is the Enemy?  Pathogens in Nosocomial Spontaneous Peritonitis (SBP)
Session: Poster Abstract Session: Epidemiology - Bacterial Infections
Friday, October 21, 2011
Room: Poster Hall B1
Background: Spontaneous bacterial peritonitis (SBP) is an important complication of patients with liver cirrhosis with a high mortality of 30-50%. Early diagnosis and treatment of the infection are key to improve the prognosis of the disease. Current treatment guidelines recommend 3rd generation cephalosporin or aminopenicillin and quinolones as the first-line treatment. Nevertheless treatment failures are common, especially in patients with nosocomial SBP that have been pretreated. This analysis focuses on the pathogens found in patients with SBP and the effectiveness of currently used treatment recommendations.

Methods: Retrospective analysis of clinical data, microbiological and laboratory results of patients with liver cirrhosis treated in the department of internal medicine at a tertiary care hospital in Germany. Patients were identified by searching the electronic case files for the words “liver cirrhosis” and “liver failure” and treatment between January 2005 and June 2008.

Results: 530 patients with liver cirrhosis could be identified (52 ± 10 years). 436 bacterial cultures of ascites were performed from a total of 194 patients. In 49 probes pathogens could be identified from 40 distinct patients, 6 cultures grew 2 or more pathogens.  In 26% (n=13) enterococci were identified, in 20% (n=10) Candida spp. . Only 10% (n=5) were positive for E.coli. The rate of nosocomial infections was very high with 92% of all positive probes.

Conclusion: The pathogens found do not correlate with what would be expected from the literature currently available which is the basis for current treatment guidelines. Especially fungal pathogens and enterococci are not covered by the empirical treatment. Therefore new guidelines may be needed for patients with nosocomial spontaneous peritonitis in order to improve patient care.

Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Christine Dierkes, MD1, Frank Hanses, MD1, Reiner Wiest, MD2, Bernd Salzberger, MD1 and Sylvia Pemmerl, MD2, (1)Dept. of Infectious Diseases, University Hospital Regensburg, Clinic for Internal Medicine I, Regensburg, Germany, (2)Dept. of Internal Medicine 1, University Hospital Regensburg, Regensburg, Germany


C. Dierkes, None

F. Hanses, None

R. Wiest, None

B. Salzberger, None

S. Pemmerl, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.