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The empirical antibiotic treatment of nosocomial spontaneous bacterial peritonitis: Results of a randomized controlled clinical trial.
Hepatology. 2015 Jun 18;
Authors: Piano S, Fasolato S, Salinas F, Romano A, Tonon M, Morando F, Cavallin M, Gola E, Sticca A, Loregian A, Palù G, Zanus G, Senzolo M, Burra P, Cillo U, Angeli P
Abstract
Spontaneous bacterial peritonitis (SBP) is a common and life-threatening complication of liver cirrhosis. Third-generation cephalosporins have been considered the first-line treatment of SBP. In 2014, a panel of experts suggested a broader spectrum antibiotic regimen for nosocomial SBP, according to the high rate of bacteria resistant to third-generation cephalosporins found in these patients. However, a broader spectrum antibiotic regimen has never been compared to third-generation cephalosporins in the treatment of nosocomial SBP. The aim of our study was to compare meropenem plus daptomycin versus ceftazidime in the treatment of nosocomial SBP. Patients with cirrhosis and nosocomial SBP were randomized to receive meropenem (1g/8 hours) plus daptomycin (6mg/kg/day) or ceftazidime (2g/8 hours). A paracentesis was performed after 48 hours of treatment. A reduction in ascitic fluid neutrophil count <25% of pre-treatment value was considered a treatment failure. The primary outcome was the efficacy of treatment defined by the resolution of SBP after 7 days of treatment. Thirty-two patients were randomized and thirty-one were analyzed. The combination of meropenem plus daptomycin was significantly more effective than ceftazidime in the treatment of nosocomial SBP (86.7vs25%; p<0.001). Ninety-day transplant-free survival was not significantly different between the two groups. In the multivariate analysis, the ineffective response to first-line treatment (hazard ratio[HR]:20.6; p=0.01), the development of acute kidney injury during hospitalization (HR:23.2; p=0.01) and baseline mean arterial pressure (HR:0.92; p=0.01) were found to be independent predictors of 90-day transplant-free survival.
CONCLUSION: The combination of meropenem plus daptomycin is more effective than ceftazidime as empirical antibiotic treatment of nosocomial SBP. The efficacy of the empirical antibiotic treatment is a strong predictor of 90-day survival in patients with nosocomial SBP. This article is protected by copyright. All rights reserved.
PMID: 26084406 [PubMed - as supplied by publisher]