Cephalosporin resistance in community acquired spontaneous bacterial peritonitis

  • Shahid Sarwar Services Institute of Medical Sciences
  • Shandana Tarique King Edward Medical University Lahore
  • Umaima Waris Services Institute of Medical Sciences
  • Anwaar Ahmad Khan Doctors Hospital and Medical Center
Keywords: Cephalosporins, In-hospital mortality, Resistance, Spontaneous bacterial peritonitis.


Objective: To determine 3rd generation cephalosporin resistance in patients with community-acquired spontaneous bacterial peritonitis (SBP) using early response assessment.

Methods: This prospective quasi-experimental study was carried out at Doctors Hospital & Medical Center from January 2016 to September 2018. Patients with cirrhosis and SBP were included. Third generation cephalosporins i.e. cefotaxime/ceftriaxone were used for treatment of SBP. Response after 48 hours was assessed and decline in ascitic fluid neutrophil count of < 25% of baseline was labelled as cephalosporin resistant. Carbapenem were used as second line treatment. Recovery and discharge or death of patients were primary end points.

Results: Male to female ratio in 31 patients of SBP was 1.2/1 (17/14). Hepato-renal syndrome was diagnosed in 11(37.9%) patients. Cefotaxime was used for 16(51.6%) patients whereas ceftriaxone for 15(48.3%) patients. Early response of SBP was noted in 26(83.8%) patients while 5 (16.2%) were non-responders to cephalosporins. SBP resolved in all non-responding patients with i/v carbapenem. In-hospital mortality was 12.9% and had no association with cephalosporin resistance. High bilirubin (p 0.04), deranged INR (p 0.008), low albumin (p 0.04), high Child Pugh (CTP) score (p 0.03) and MELD scores (p 0.009) were associated with in-hospital mortality.

Conclusion: Cephalosporin resistance was present in 16.2% of study patients with community-acquired SBP. Mortality in SBP patients is associated with advanced stage of liver disease.

How to cite this:
Sarwar S, Tarique S, Waris U, Khan AA. Cephalosporin resistance in community acquired spontaneous bacterial peritonitis. Pak J Med Sci. 2019;35(1):4-9. doi: https://doi.org/10.12669/pjms.35.1.17

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Author Biographies

Shandana Tarique, King Edward Medical University Lahore

Professor of Medicine

King Edward Medical University

Umaima Waris, Services Institute of Medical Sciences

Trainee Resident of Medicine

Anwaar Ahmad Khan, Doctors Hospital and Medical Center

Ex-Professor of Gastroenterology

Shaikh Zayed Post Graduate Medical Institution

Consultant Gastroenterologist 

Doctors Hospital Lahore

Original Articles