Efficacy predictors of third-generation cephalosporins in treating spontaneous bacterial peritonitis

Objective: Third-generation cephalosporins (3(rd) GCs) have recently become controversial as the first-line strategy for empirical spontaneous bacterial peritonitis (SBP) treatment. This study aimed to identify SBP treatment efficacy predictors of 3(rd) GCs. Methods: In this retrospective cohort study, 279 cirrhosis patients with SBP who received 3(rd) GC monotherapy for initial empirical treatment from 2013 to 2019 were included. Nonresponse was defined as a decreased ascites polymorphonuclear (PMN) count < 25% from baseline after 48 hours of antibacterial treatment. Multivariate regression analysis was used to identify efficacy predictors of 3(rd) GCs in treating SBP. Kaplan-Meier analysis was used to evaluate survival data. Results: The nonresponder group included 120 patients with no response, and the responder group included 159 patients with responses. The response rate to 3(rd) GCs was 57.0% among all patients. The common pathogens were Escherichia coli (40.6%), Staphylococcus (15.6%), Klebsiella pneumonia (12.5%), and Streptococcus (12.5%) in 32 ascites culture isolates. Nosocomial SBP (NSBP) (odds ratio [OR]: 2.371, 95% confidence interval [CI]: 1.323-4.249, P = .004), pneumonia (OR: 11.561, 95% CI: 1.876-71.257, P = .008), recurrent SBP (OR: 3.386, 95% CI: 1.804-6.357, P < .001), platelet count (>= 113.5 x 10(9)/L) (OR: 3.515, 95% CI: 1.973-6.263, P < .001), and ascites PMN count (<= 0.760 x 10(9)/L) (OR: 4.967, 95% CI: 2.553-9.663, P < .001) were independent predictors of nonresponse to 3(rd) GCs against SBP. Survival plot analysis at 30 days showed worse survival for the nonresponders (P = .003). Conclusion: NSBP, pneumonia, recurrent SBP, increased platelet count, and lower ascites PMN count were independent predictors of nonresponse to 3(rd) GC in treating SBP. Nonresponse to initial antibiotic treatment was associated with worse survival.