Empirical Treatment With Carbapenem vs Third-generation Cephalosporin for Treatment of Spontaneous Bacterial Peritonitis

Sun Woong Kim, Jun Sik Yoon, Junyong Park, Yong Jin Jung, Jae Seung Lee, Jisoo Song, Han Ah Lee, Yeon Seok Seo, Minjong Lee, Jin Myung Park, Dae Hee Choi, Moon Young Kim, Seong Hee Kang, Jin Mo Yang, Do Seon Song, Sung Won Chung, Minseok Albert Kim, Hee Joon Jang, Hyunwoo Oh, Cheol Hyung LeeYun Bin Lee, Eun Ju Cho, Su Jong Yu, Yoon Jun Kim, Jung Hwan Yoon, Jeong Hoon Lee

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13 Scopus citations

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.

Original languageEnglish
Pages (from-to)976-986.e5
JournalClinical Gastroenterology and Hepatology
Volume19
Issue number5
DOIs
StatePublished - May 2021

Bibliographical note

Funding Information:
Funding Supported by grants from Liver Research Foundation of Korea as part of Bio Future Strategies Research Project, Seoul National University Hospital Research Fund (grant number 03-2016-0380 ), and from the National Research Foundation of Korea (NRF) grants funded by the Korea government (MSIP) (grant number NRF-2019R1A2C2010311 ).

Funding Information:
Funding Supported by grants from Liver Research Foundation of Korea as part of Bio Future Strategies Research Project, Seoul National University Hospital Research Fund (grant number 03-2016-0380), and from the National Research Foundation of Korea (NRF) grants funded by the Korea government (MSIP) (grant number NRF-2019R1A2C2010311). Conflicts of interest These authors disclose the following: Jeong-Hoon Lee reports receiving lecture fee from GreenCross Cell, Daewoong Pharmaceuticals, and Gilead Korea. Yun Bin Lee reports receiving grant from Samjin Pharmaceuticals. Su Jong Yu reports lecture fee from Bayer HealthCare Pharmaceuticals. Yoon Jun Kim reports research grants from Bristol-Myers Squibb, Roche, Gilead Sciences, LG Sciences, Ildong Pharmaceuticals, Daewoong Pharmaceuticals, Hanmi Pharmaceuticals, Yuhan Pharmaceuticals, and Bayer Pharmaceuticals and lecture fees from Bristol-Myers Squibb, MSD Korea, Bayer Pharmaceuticals, BTG, and Gilead Sciences. Jung-Hwan Yoon reports research grants from Bayer HealthCare Pharmaceuticals, Daewoong Pharmaceuticals, and Bukwang Pharmaceuticals. The remaining authors disclose no conflicts.

Publisher Copyright:
© 2021 AGA Institute

Keywords

  • Ascites
  • Cirrhosis
  • Risk of Death
  • Therapy

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