%0 Journal Article
%T Towards evidence-based empiric antibiotic recommendations for spontaneous infections in patients with cirrhosis.
%A Dirchwolf M
%A Gomez Perdiguero G
%A Cairo F
%A Vazquez C
%A Notari L
%A Murga MD
%A Elizondo M
%A Bessone F
%A Agozino M
%A Brutti J
%A Zerega AR
%A Pages J
%A Stieben TE
%A Calzetta P
%A Arufe D
%A González Ballerga E
%A Giunta D
%A Smud A
%A Osso Sanchez B
%A Navarro L
%A Palazzo A
%A Valverde M
%A Gadano A
%A Marciano S
%J Dig Liver Dis
%V 0
%N 0
%D 2024 Aug 5
%M 39107169
%F 5.165
%R 10.1016/j.dld.2024.07.023
%X <B>BACKGROUND: </B>With the emergence of multidrug-resistant infections, healthcare professionals must evaluate the effectiveness of empiric antibiotic treatments.<BR><B>OBJECTIVE: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>Our study uncovers inadequate coverage in specific clinical scenarios when adhering to recommendations, underscoring the necessity of guidelines based on local epidemiological data.