1296. Clinical Outcomes of Spontaneous Bacterial Peritonitis due to Extended-Spectrum Beta-Lactamase Producing Escherchia coli and Klebsiella pneumonia
Session: Poster Abstract Session: Below the Diaphragm
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 1296.pdf (95.8 kB)
  • Background: The aim of this study was to evaluate the outcomes of spontaneous bacterial peritonitis(SBP) due to extended-spectrum beta-lactamase producing bacteria and to investigate effect of early antibiotics choice on those outcomes.

    Methods: We conducted a retrospective cohort study to evaluate the outcomes of SBP caused by Escherichia coli or Klebsiella pneumoniae. We reviewed the medical records of patients (1) with a diagnosis of liver cirrhosis, (2) symptoms and signs compatible with SBP and (3) ascites cultures positive for E. coli or K. pneumoniae or blood cultures positive for the same organisms with compatible ascites profiles. We used 7-day and 30-day mortality as surrogates for the clinical outcome. 

    Results: Between Jan 2006 and Dec 2012, a total of 231 episodes of SBP caused by E. coli or K. pneumoniae were recorded. Among them, 52 were caused by ESBL-producing organisms. Moreover, 7-day and 30-day mortality were significantly higher among patients with SBP caused by ESBL-producing bacteria, than those by non-ESBL-producing bacteria (21.2% vs. 10.1% [P = 0.033] and 34.6% vs. 18.4% [P= 0.013], respectively).

    Multivariate analysis revealed ESBL-producing bacterial infection (adjusted OR = 2.30, 1.07-4.96), septic shock (aOR = 4.35, 2.45-7.73), Child Pugh Score (aOR = 1.55, 1.28-1.88) and Charlson Comorbidity Index (aOR = 1.40, 1.17-1.68) to be independent risk factors for 30-day mortality in all the patients with SBP. When we evaluated risk factors for 30-day mortality in patients with SBP caused by ESBL-producing organisms, septic shock (aOR = 7.53, 2.43-23.28) was the only significant variable.

    Conclusion: The findings of this study indicate that 7-day and 30-day mortality for SBP due to ESBL producing bacteria were significantly higher than those for SBP due to non-ESBL-producing bacteria. The adequacy of initial empirical antibiotics was not associated with 30-day mortality of SBP due to ESBL-producing bacteria.

    Table 1. Risk factors for 30-day mortality in cirrhotic patients with SBP
    Variable   aOR     95% CI   P-value
     All patients (n=231)
       Infection by ESBL- producing bacteria   2.30   1.07 – 4.96    0.034
       Septic shock   4.66   2.16 – 10.04   <0.001
       Child Pugh Score   1.60   1.26 – 2.04   <0.001
       Charlson Comorbidity Index   1.49   1.18 – 1.88    0.001
     Patients with SBP due to ESBL-producing bacteria (n=52)
       Septic shock   3.73   1.04 – 13.45    0.044

    Min Jae Kim, MD1, Nak-Hyun Kim, MD1, Kyoung-Ho Song2, Eu Suk Kim3, Hong Bin Kim2, Ji-Hwan Bang, MD, PhD4, Sang-Won Park, MD4, Pyoeng Gyun Choe, MD3, Myoung-Don Oh, MD1 and Nam-Joong Kim, MD1, (1)Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea, (2)Seoul National University Bundang Hospital, Seongnam, South Korea, (3)Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea, (4)Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea

    Disclosures:

    M. J. Kim, None

    N. H. Kim, None

    K. H. Song, None

    E. S. Kim, None

    H. B. Kim, None

    J. H. Bang, None

    S. W. Park, None

    P. G. Choe, None

    M. D. Oh, None

    N. J. Kim, None

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