Microbiological profile of ascitic fluid infection at Mohammed VI University Hospital in Oujda: A prospective and descriptive study

##plugins.themes.academic_pro.article.main##

Kaoutar Ghomari
Abderrazak Saddari
Oumayma Abdessalami
Chaymae Benmoussa
Sabrina Belmahi
Hajar Zrouri
Said Ezrari
Elmostapha Benaissa
Yassine Ben Lahlou
Mostafa Elouennass
Adil Maleb

Abstract

Introduction-Aim: Spontaneous bacterial peritonitis (SBP) is a common complication in cirrhotic patients and is associated with a high mortality rate. The aim of this study is to determine the epidemiological and bacteriological profile of spontaneous bacterial peritonitis, as well as antibiotic resistance among hospitalized patients at CHU Mohammed VI, in order to guide empirical antibiotic choices for better management.


Methods: This is a prospective study conducted over a period of 12 months, from January to December 2023, focusing on all requests for bacteriological examination of ascitic fluid samples. All samples received at the microbiology laboratory were processed according to the Medical Microbiology Reference Standard (Remic)


Results: A total of 137 ascitic fluid samples were included. The main etiologies implicated in ascites were cirrhosis (50.36% of cases), followed by neoplastic pathology (24.1% of cases). The prevalence of spontaneous bacterial peritonitis was 13.87%, of which 63.16% corresponded to neutrocytic ascites with negative culture. The rate of bacterascite was 74.07%. Gram-positive cocci constituted the majority of pathogens (56.67%), with 43.33% corresponding to Gram-negative bacilli. 28.57% of coagulase-negative Staphylococci were methicillin-resistant. Quinolone resistance was observed in 23.53% of Gram-positive cocci, and 69.23% of isolated Enterobacteriaceae were multidrug-resistant.


Conclusion: The prevalence of SBP due to Gram-positive and multidrug-resistant bacteria has increased in recent years. The currently recommended empirical antibiotic therapy, based on third-generation cephalosporins, carries a high risk of failure and may need to be reassessed.

Keywords:

peritonitis, infection, pathogen, antibiotic resistance

##plugins.themes.academic_pro.article.details##

References

  1. Hurwich DB, Lindor KD, Hay JE, Gross JB, Kaese D, Rakela J. Prevalence of Peritonitis and the Ascitic Fluid Protein Concentration among Chronic Liver Disease Patients. The American Journal of Gastroenterology [Internet]. 1993 [cited 2024 Jan 27];88(8):1254–7. Available from: https://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=00029270&AN=16003762&h=68KsqWvATUqIDWlAVNfcXSqgnK45v4C4%2BHgcfiNafOE6WBxNKhoQCeWC%2Ft2jO8MrCTmUI6Vf94viscVAicSkUw%3D%3D&crl=c
  2. Navasa M, Rodés J. Bacterial infections in cirrhosis [Internet]. Vol. 24, Liver International. Liver Int; 2004 [cited 2023 Nov 8]. p. 277–80. Available from: https://pubmed.ncbi.nlm.nih.gov/15287849/
  3. Maslennikov R, Pavlov C, Ivashkin V. Small intestinal bacterial overgrowth in cirrhosis: systematic review and meta-analysis. Hepatology International. 2018 Nov 1;12(6):567–76.
  4. Runyon BA, Canawati HN, Akriviadis EA. Optimization of ascitic fluid culture technique. Gastroenterology. 1988 Nov 1;95(5):1351–5.
  5. Fiore M, Maraolo AE, Gentile I, Borgia G, Leone S, Sansone P, et al. Current concepts and future strategies in the antimicrobial therapy of emerging Gram-positive spontaneous bacterial peritonitis. Vol. 9, World Journal of Hepatology. Baishideng Publishing Group Co; 2017. p. 1166–75.
  6. Suppurations closes liquides de séreuses infectées. I: R: SF de ME 2022: p. 36.-368. Référentiel en microbiologie médicale. 2022.
  7. Carrier P, Jacques J, Debette-Gratien M, Legros R, Sarabi M, Vidal E, et al. L’ascite non liée à la cirrhose: Physiopathologie, diagnostic et étiologies. Vol. 35, Revue de Medecine Interne. Elsevier Masson; 2014. p. 365–71.
  8. Li YT, Yu CB, Huang JR, Qin ZJ, Li LJ. Pathogen profile and drug resistance analysis of spontaneous peritonitis in cirrhotic patients. World Journal of Gastroenterology [Internet]. 2015 Sep 28 [cited 2024 Jan 15];21(36):10409–17. Available from: https://pubmed.ncbi.nlm.nih.gov/26420967/
  9. Hébuterne X, Stratton R, Elia M. JFHOD | SNFGE.org - Société savante médicale française d’hépato-gastroentérologie et d’oncologie digestive [Internet]. 2011 [cited 2024 Jan 29]. Available from: https://www.snfge.org/content/infection-du-liquide-dascite-dans-les-0
  10. Kamani L, Mumtaz K, Ahmed US, Ali AW, Jafri W. Outcomes in culture positive and culture negative ascitic fluid infection in patients with viral cirrhosis: Cohort study. BMC Gastroenterology. 2008 Dec 18;8.
  11. Oladimeji AA, Temi AP, Adekunle AE, Taiwo RH, Ayokunle DS. Prevalence of spontaneous bacterial peritonitis in liver cirrhosis with ascites. The Pan African medical journal [Internet]. 2013 [cited 2024 Jan 31];15:128. Available from: https://www.ajol.info/index.php/pamj/article/view/100141
  12. Wiest R, Krag A, Gerbes A. Spontaneous bacterial peritonitis: Recent guidelines and beyond [Internet]. Vol. 61, Gut. Gut; 2012 [cited 2024 Jan 26]. p. 297–310. Available from: https://pubmed.ncbi.nlm.nih.gov/22147550/
  13. Fiore M, Maraolo AE, Gentile I, Borgia G, Leone S, Sansone P, et al. Nosocomial spontaneous bacterial peritonitis antibiotic treatment in the era of multi-drug resistance pathogens: A systematic review [Internet]. Vol. 23, World Journal of Gastroenterology. World J Gastroenterol; 2017 [cited 2023 Dec 20]. p. 4654–60. Available from: https://pubmed.ncbi.nlm.nih.gov/28740354/
  14. Fernández J, Navasa M, Gómez J, Colmenero J, Vila J, Arroyo V, et al. Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology [Internet]. 2002 [cited 2024 Feb 12];35(1):140–8. Available from: https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1053/jhep.2002.30082
  15. Campillo B, Dupeyron C, Richardet JP, Mangeney N, Leluan G. Epidemiology of severe hospital-acquired infections in patients with liver cirrhosis: Effect of long-term administration of norfloxacin. Clinical Infectious Diseases [Internet]. 1998 [cited 2024 Feb 12];26(5):1066–70. Available from: https://academic.oup.com/cid/article-abstract/26/5/1066/320863
  16. Mane M, Mane P, Prajapati P, Afzalpurkar S, Aundhakar A, John D. Study of Frequency of Spontaneous Bacterial Peritonitis in Patients with Alcoholic Liver Cirrhosis with Ascites. International Journal of Contemporary Medical Research ISSN (Online [Internet]. 2016 [cited 2024 Mar 28];43(7):2393–915. Available from: https://www.academia.edu/download/88659092/ijcmr_742_jul_11.pdf
  17. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clinical Microbiology and Infection [Internet]. 2012 [cited 2024 Jan 17];18(3):268–81. Available from: https://pubmed.ncbi.nlm.nih.gov/21793988/
  18. Sunjaya DB, Lennon RJ, Shah VH, Kamath PS, Simonetto DA. Prevalence and Predictors of Third-Generation Cephalosporin Resistance in the Empirical Treatment of Spontaneous Bacterial Peritonitis. Mayo Clinic Proceedings. 2019 Aug 1;94(8):1499–508.
  19. Umgelter A, Reindl W, Miedaner M, Schmid RM, Huber W. Failure of current antibiotic first-line regimens and mortality in hospitalized patients with spontaneous bacterial peritonitis. Infection [Internet]. 2009 Feb [cited 2024 Feb 10];37(1):2–8. Available from: https://link.springer.com/article/10.1007/s15010-008-8060-9
  20. Alexopoulou A, Papadopoulos N, Eliopoulos DG, Alexaki A, Tsiriga A, Toutouza M, et al. Increasing frequency of gram-positive cocci and gram-negative multidrug-resistant bacteria in spontaneous bacterial peritonitis. Liver International [Internet]. 2013 Aug [cited 2024 Jan 28];33(7):975–81. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/liv.12152