Empirical Treatment With Carbapenem vs Third-generation Cephalosporin for Treatment of Spontaneous Bacterial Peritonitis
- Kim, S.W.; Yoon, J.S.; Park, J.; Jung, Y.J.; Lee, J.S.; Song, J.; Lee, H.A.; Seo, Y.S.; Lee, M.; Park, J.M.; Choi, D.H.; Kim, M.Y.; Kang, S.H.; Yang, J.M.; Song, D.S.; Chung, S.W.; Kim, M.A.; Jang, H.J.; Oh, H.; Lee, C.-H.; Lee, Y.B.; Cho, E.J.; Yu, S.J.; Kim, Y.J.; Yoon, J.-H.; Lee, J.-H.
- Issue Date
- W.B. Saunders
- Ascites; Cirrhosis; Risk of Death; Therapy
- Clinical Gastroenterology and Hepatology, v.19, no.5, pp.976 - 986.e5
- Journal Title
- Clinical Gastroenterology and Hepatology
- Start Page
- End Page
- Background & Aims: Third-generation cephalosporins (TGCs) are recommended as first-line antibiotics for treatment of spontaneous bacterial peritonitis (SBP). However, antibiotics against multidrug-resistant organisms (such as carbapenems) might be necessary. We aimed to evaluate whether carbapenems are superior to TGC for treatment of SBP. Methods: We performed a retrospective study of 865 consecutive patients with a first presentation of SBP (275 culture positive; 103 with TGC-resistant bacterial infections) treated at 7 referral centers in Korea, from September 2013 through January 2018. The primary outcome was in-hospital mortality. We made all comparisons using data from patients whose baseline characteristics were balanced by inverse probability of treatment weighting. Results: Of patients who initially received empirical treatment with antibiotics, 95 (11.0%) received carbapenems and 655 (75.7%) received TGCs. Among the entire study cohort, there was no significant difference in in-hospital mortality between the carbapenem (25.8%) and TGC (25.3%) groups (adjusted odds ratio [aOR], 0.97; 95% CI, 0.85–1.11; P =. 66). In the subgroup of patients with high chronic liver failure-sequential organ failure assessment (CLIF-SOFA) scores (score of 7 or greater, n = 314), carbapenem treatment was associated with lower in-hospital mortality (23.1%) than in the TGC group (38.8%) (aOR, 0.84; 95% CI, 0.75–0.94; P=.002). In contrast, among patients with lower CLIF-SOFA scores (n = 436), in-hospital mortality did not differ significantly between the carbapenem group (24.7%) and the TGC group (16.0%) (aOR, 1.06; 95% CI, 0.85–1.32; P =. 58). Conclusions: For patients with a first presentation of SBP, empirical treatment with carbapenem does not reduce in-hospital mortality compared to treatment with TGCs. However, among critically ill patients (CLIF-SOFA scores ≥7), empirical carbapenem treatment was significantly associated with lower in-hospital mortality than TGCs. © 2021 AGA Institute
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