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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 Lee  ;  Yun Bin Lee  ;  Eun Ju Cho  ;  Su Jong Yu  ;  Yoon Jun Kim  ;  Jung-Hwan Yoon  ;  Jeong-Hoon Lee 
 CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, Vol.19(5) : 976-98600000, 2021-05 
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Ascites ; Cirrhosis ; Risk of Death ; Therapy
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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
Lee, Jae Seung(이재승) ORCID logo https://orcid.org/0000-0002-2371-0967
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