C0514 - Epidemiological Data and Anti-Microbial Resistance of Nosocomial Spontaneous Bacterial Peritonitis: A Systematic Review and Meta-Analysis

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Mubeen Khan Mohammed Abdul, MD

Advocate Aurora St. Luke's Medical Center
Milwaukee, WI

Mubeen Khan Mohammed Abdul, MD¹, Karim Osman, MD², Joseph M. Cappuccio, DO², Carol Spencer, ², Satheesh P. Nair, MD, FACG³
¹Advocate Aurora St. Luke's Medical Center, Milwaukee, WI; ²Lahey Hospital & Medical Center, Burlington, MA; ³James D. Eason Transplant Institute, Methodist University, University of Tennessee Health Science Center, Memphis, TN

Introduction: Nosocomial Spontaneous Bacterial Peritonitis (NSBP) incidence has been on the
rise due to frequent hospitalizations in the cirrhotic population along with rampant antibiotic use. There has been a shift in the bacterial spectrum including resistance profile with emergence of Multi Drug Resistant Organisms. The incidence of NSBP has not been studied. Furthermore, the rate of resistance to first-line agents in the management of SBP is not well reported in NSBP. Thus, we conducted a systematic review and meta-analysis of available literature.

Methods: A comprehensive search of several databases from each database's inception to
May 2022 was conducted. The databases included PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus. Studies included in the systematic review met the following inclusion criteria: adult patients, age >18 years, with a diagnosis of NSBP. NSBP was diagnosed as SBP diagnosed ≥ 48 hours of hospitalization. Studies that did not report the prevalence of NSBP or the incidence of anti-microbial resistance in NSBP were excluded. Data synthesis was obtained using random-effects meta-analysis. Pooled estimates were calculated following the restricted maximum likelihood method. Heterogeneity was reported as I2.

Results: After excluding the duplicates, a total of 482 unique titles were screened. Sixteen articles were included (Figure). The study characteristics are shown in Table 1. Eleven studies reported the prevalence of NSBP. The pooled incidence of NSBP was 9.45% [95% confidence interval (CI) 3.82-21.49%; I²99.40%]. Fifteen studies reported the resistance to ceftriaxone and only 8 studies reported the resistance to fluoroquinolones. The pooled incidence of resistance to ceftriaxone was 27.72% (95% CI 2.13-35.26%; I²84.52%). Similarly, the pooled incidence of resistance to fluoroquinolones was 24.71% (95% CI 18.19-32.64%; I²80.25%).

Discussion: The incidence of NSBP in patients with cirrhosis is relatively high. The rates of bacterial resistance to the first-line anti-microbial agents used to treat SBP (i.e., ceftriaxone/fluoroquinolones) is exceptionally high in this patient population. Thus, in patients with NSBP who fail to improve, providers should have a high level of suspicion for drug-resistance being a contributing factor. Furthermore, the high resistance rates to fluoroquinolones in NSBP should be taken into consideration when placing this patient population on secondary prophylaxis.

Figure: Flow Chart of Literature Search and article selection.

Study	Year of Publication	Age	Sex	Number of Patients with Cirrhosis	Number of NSBP Patients.	Resistant to third generation cephalosporins.	Resistanceto Fluroquinoles.
Friedrich et al	2015	57	NS	311	218 (65%)	Not specified (NS)	Not specified.
Salerno et al	2016	NS	NS	308	24	NS	NS
Shultablers et al	2020	56 +_{_}11	NS	514	127	NS	NS
Balaraju et al	2017	48.4+-14	NS	706	21	NS	NS
Jain et al	2019	48 (29-71)	19	870	19	NS	NS
Kim et al	2012	50.1 +- 9.4	16	130	19	1	NS
Kimmann et al	2018	56 (49-63)	128	1011	203	NS	NS
Li et al	2015	NS	NS	6086	99	NS	NS
Song et al	2006	58(8.7)	NS	106	32	14	8
Lan Juan Li et al	2015	55(23-79)	NS	6086	65	11	19
Elshamy et al	2022	45(30-80)	42	NS	68	13	12
Lutz et al	2016	59 (51-69)	56	NS	63	9	14
Bert et al	2003	50 26-80	NS	NS	53	13	22
Ding et al	2019	56.3 +_{_}10.3	127	NS	155	27	23
Chon et al	2014	NS	NS	NS	NS	NS	NS
Piroth et al	2014	NS	NS	1659	NS	72	62

Table: Table-1 Study characteristics

Disclosures:

Mubeen Khan Mohammed Abdul indicated no relevant financial relationships.

Karim Osman indicated no relevant financial relationships.

Joseph Cappuccio indicated no relevant financial relationships.

Carol Spencer indicated no relevant financial relationships.

Satheesh Nair indicated no relevant financial relationships.

Mubeen Khan Mohammed Abdul, MD¹, Karim Osman, MD², Joseph M. Cappuccio, DO², Carol Spencer, ², Satheesh P. Nair, MD, FACG³. C0514 - Epidemiological Data and Anti-Microbial Resistance of Nosocomial Spontaneous Bacterial Peritonitis: A Systematic Review and Meta-Analysis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.