Abstract：
BACKGROUND: With the emergence of multidrug-resistant infections, healthcare professionals must evaluate the effectiveness of empiric antibiotic treatments.
OBJECTIVE: To assess the antibiotic susceptibility patterns of microorganisms causing spontaneous infections in patients with cirrhosis and to evaluate the suitability of empiric antibiotic treatments based on major clinical guidelines.
METHODS: This cross-sectional study utilized two datasets from prospective studies of patients with cirrhosis and culture-positive spontaneous bacterial infections in Argentina and Uruguay. We estimated susceptibility to commonly used antibiotics and assessed coverage following European and American recommendations.
RESULTS: We analyzed 238 episodes of culture-positive spontaneous infections in 229 patients. When implementing the recommendations for empiric treatment of community-acquired spontaneous infections, ceftazidime would result in 39 % coverage, whereas ceftriaxone would reach 70 %. Cefepime, which is not included in the recommendations, would have provided coverage of 74 %. Using ertapenem for nosocomial infections would have only covered 56 % of these episodes, whereas meropenem or imipenem reached 73 % coverage. Only the combination of meropenem or imipenem plus vancomycin would achieve a coverage surpassing 85 % in healthcare-associated or nosocomial spontaneous bacterial infections.
CONCLUSIONS: Our study uncovers inadequate coverage in specific clinical scenarios when adhering to recommendations, underscoring the necessity of guidelines based on local epidemiological data.
OBJECTIVE: To assess the antibiotic susceptibility patterns of microorganisms causing spontaneous infections in patients with cirrhosis and to evaluate the suitability of empiric antibiotic treatments based on major clinical guidelines.
METHODS: This cross-sectional study utilized two datasets from prospective studies of patients with cirrhosis and culture-positive spontaneous bacterial infections in Argentina and Uruguay. We estimated susceptibility to commonly used antibiotics and assessed coverage following European and American recommendations.
RESULTS: We analyzed 238 episodes of culture-positive spontaneous infections in 229 patients. When implementing the recommendations for empiric treatment of community-acquired spontaneous infections, ceftazidime would result in 39 % coverage, whereas ceftriaxone would reach 70 %. Cefepime, which is not included in the recommendations, would have provided coverage of 74 %. Using ertapenem for nosocomial infections would have only covered 56 % of these episodes, whereas meropenem or imipenem reached 73 % coverage. Only the combination of meropenem or imipenem plus vancomycin would achieve a coverage surpassing 85 % in healthcare-associated or nosocomial spontaneous bacterial infections.
CONCLUSIONS: Our study uncovers inadequate coverage in specific clinical scenarios when adhering to recommendations, underscoring the necessity of guidelines based on local epidemiological data.
摘要：
背景：随着多重耐药感染的出现，医疗保健专业人员必须评估经验性抗生素治疗的有效性。
目的：评估引起肝硬化患者自发性感染的微生物对抗生素的敏感性，并根据主要临床指南评估经验性抗生素治疗的适用性。
方法：这项横断面研究利用了来自阿根廷和乌拉圭的肝硬化和培养阳性自发性细菌感染患者的前瞻性研究的两个数据集。我们评估了对常用抗生素的敏感性，并根据欧洲和美国的建议评估了覆盖率。
结果：我们分析了229例患者中238例培养阳性自发性感染。在实施经验性治疗社区获得性自发性感染的建议时，头孢他啶将导致39%的覆盖率，而头孢曲松将达到70%。头孢吡肟,这不包括在建议中，将提供74%的覆盖率。使用厄他培南治疗医院感染只会覆盖这些发作的56%，而美罗培南或亚胺培南覆盖率达到73%。只有美罗培南或亚胺培南加万古霉素的组合在医疗保健相关或医院自发性细菌感染中的覆盖率超过85%。
结论：我们的研究发现，在坚持建议的情况下，在特定的临床情景中没有足够的覆盖。强调基于当地流行病学数据的指南的必要性。
目的：评估引起肝硬化患者自发性感染的微生物对抗生素的敏感性，并根据主要临床指南评估经验性抗生素治疗的适用性。
方法：这项横断面研究利用了来自阿根廷和乌拉圭的肝硬化和培养阳性自发性细菌感染患者的前瞻性研究的两个数据集。我们评估了对常用抗生素的敏感性，并根据欧洲和美国的建议评估了覆盖率。
结果：我们分析了229例患者中238例培养阳性自发性感染。在实施经验性治疗社区获得性自发性感染的建议时，头孢他啶将导致39%的覆盖率，而头孢曲松将达到70%。头孢吡肟,这不包括在建议中，将提供74%的覆盖率。使用厄他培南治疗医院感染只会覆盖这些发作的56%，而美罗培南或亚胺培南覆盖率达到73%。只有美罗培南或亚胺培南加万古霉素的组合在医疗保健相关或医院自发性细菌感染中的覆盖率超过85%。
结论：我们的研究发现，在坚持建议的情况下，在特定的临床情景中没有足够的覆盖。强调基于当地流行病学数据的指南的必要性。
