Predictive factors for third-generation cephalosporin-resistant spontaneous bacterial peritonitis

Objective To investigate the predictive factors for third-generation cephalosporin-resistant spontaneous bacterial peritonitis ( SBP) . Methods A retrospective analysis was performed for the clinical data of 206 patients with liver cirrhosis who were hospitalized in the Ninth Hospital of Nanchang from January 2010 to December 2018, and all patients had SBP with positive bacteria based on ascites culture. According to drug susceptibility results, the patients were divided into third-generation cephalosporin-resistant SBP group ( 101 patients with third-generation cephalosporin-resistant pathogenic bacteria in ascites) and control group ( 105 patients with pathogenic bacteria sensitive to third-generation cephalosporin) . Electronic medical records were reviewed to collect related information. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of data with skewed distribution between groups. The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. A dichotomous logistic regression analysis was used for multivariate analysis, and the Forward: LR method was used for the screening of independent variables. Results There was a significant difference in the composition of pathogenic bacteria between the two groups ( P <0. 001) . The univariate analysis showed that a history of broad-spectrum antibiotic exposure in the past three months ( χ2= 12. 351, P <0. 001) , non-first-time onset of SBP ( χ2= 14. 427, P < 0. 001) , blood creatinine ( χ2=-2. 537, P = 0. 011) , and blood bicarbonate ( χ2=-4. 592, P < 0. 001) were candidate predictive factors with statistical significance between the two groups, and further multivariate analysis showed that a history of broad-spectrum antibiotic exposure in the past three months ( odds ratio [OR]= 2. 376, 95% confidence interval [CI]: 1. 009-5. 598, P = 0. 048) , non-first-time onset of SBP ( OR = 2. 841, 95% CI: 1. 133-7. 122, P = 0. 026) , and blood bicarbonate ( OR = 0. 892, 95% CI: 0. 818-0. 973, P = 0. 010) had an independent predictive value for third-generation cephalosporin-resistant SBP. Conclusion A history of broad-spectrum antibiotic exposure in the past three months, non-first-time onset of SBP, and a low level of blood bicarbonate are independent predictive factors for third-generation cephalosporin-resistant SBP, and third-generation cephalosporins should be used with caution in SBP patients with these features.