Changing epidemiology and predictors of mortality in patients with spontaneous bacterial peritonitis at a liver transplant unit

Abstract

Objectives. To determine whether antimicrobial resistance in pathogens and outcome in patients with spontaneous bacterial peritonitis (SBP) has evolved over time. Methods. Sixty-one consecutive episodes of SBP were studied in patients with end-stage liver disease undergoing evaluation for liver transplantation between 1991 and 2001. Patients were dichotomized into a cohort between 1991 and 1995 (the earlier cohort) and 1996-2001 (the later cohort). Results. Overall, 19% of all bacteria were multiply-antibiotic resistant. The frequency of multiple-antibiotic resistance in bacteria increased from 8.3% to 38.5% in the earlier as compared to the later cohort (P = 0.07). Overall, mortality at 30 days in the study patients was 26% and had remained unchanged between the two cohorts. The mortality rate was significantly higher in patients with multiply-antibiotic-resistant bacteria than in those with other bacteria (P = 0.045). However, the Child-Pugh score (P = 0.003), and renal failure (P = 0.04) were the only independently significant predictors of mortality in patients with SBP. Conclusions. Mortality in patients with end-stage liver disease who developed SBP has remained unchanged over the last decade. Although multiple-antibiotic resistance in bacteria causing SBP has increased over time, the severity of hepatic and renal dysfunction were the predominant determinants of outcome in these patients.