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Cited 4 time in webofscience Cited 5 time in scopus
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Empirical Treatment With Carbapenem vs Third-generation Cephalosporin for Treatment of Spontaneous Bacterial Peritonitis

Authors
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
Mar-2021
Publisher
W.B. Saunders
Keywords
Ascites; Cirrhosis; Risk of Death; Therapy
Citation
Clinical Gastroenterology and Hepatology, v.19, no.5, pp.976 - 986.e5
Indexed
SCIE
SCOPUS
Journal Title
Clinical Gastroenterology and Hepatology
Volume
19
Number
5
Start Page
976
End Page
986.e5
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/52956
DOI
10.1016/j.cgh.2020.06.046
ISSN
1542-3565
Abstract
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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Anam Hospital (Department of Gastroenterology and Hepatology, Anam Hospital)
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