Publication

Abstract : Background and Aim: Spontaneous bacterial peritonitis(SBP) is a life-threatening decompensation, associated with poor prognosis, higher rates of organ failure and mortality. Despite advancements in early diagnosis and prophylactic strategies, rising burden of multidrug-resistant organisms(MDROs) and antibiotic failure has significantly impacted clinical outcomes. This study aimed to evaluate the evolving microbiological profile of nosocomial SBP. Methods: We conducted a retrospective single-center study at tertiary care hepatology unit in Southern India. Adult cirrhotics with nosocomial culture-positive SBP were included. Microbiological profile, prevalence of organ failure, association between SBP prophylaxis and antimicrobial resistance, and their impact on mortality were evaluated. Results: Our cohort (n=61;mean age 55 ± 6.4 years; 88.5% males), exhibited markedly elevated CRP(51.8 ± 52.3 mg/L), procalcitonin(11.4 ± 4.9 ng/mL), bilirubin, INR, and creatinine, alongwith low Hb. Ascitic fluid analysis revealed significantly high TLC(1737 ± 2592 cells/mmÂ3) with low protein(0.97 ± 0.81 g/dL) and albumin(0.72 ± 0.62 g/dL). Acute decompensation(46%) and ACLF(31%) were the predominant clinical presentations, with incidence of organ failures documented in 67%, mainly hepatic(68%), coagulation(46%), respiratory and renal (39% each). Norfloxacin prophylaxis failure was observed in 39%. MDROs comprised 52.5% isolates, with CRE(29.5%) and ESBL producers(21.3%) predominating; pan-resistant strains isolated in two patients. Klebsiella pneumoniae(34%) and Staphylococcus spp.(20%) accounted for majority of MDR pathogens, followed by E.coli, Enterococcus, and Burkholderia spp(16.4% each). Survival analysis revealed significantly lower median survival in MDRO-infected cirrhotics(HR=1.52) with predictors of mortality being circulatory failure(p=0.024), renal failure(p<0.001), need for ventilatory support(p=0.05), elevated day-3 CRP(p=0.002), elevated INR(p=0.05), UGIB(p=0.046), Norfloxacin prophylaxis failure(p=0.01), leukocytosis(p=0.001), presence of MDROs(p=0.028), especially XDROs(p=0.037). Conclusion: MDRO-related SBP is associated with high short-term mortality, pronounced multi-organ dysfunction, and rapid clinical deterioration. Circulatory and renal failures, ACLF grade>II, MDRO infection independently predict 30-day mortality. Early diagnosis, individualized antimicrobial therapy, and optimized prophylactic strategies crucial to improving outcomes in this high-risk population.