Nosocomial vs healthcare associated vs community acquired spontaneous bacterial peritonitis: Network meta-analysis

Amna Iqbal; Manesh Kumar Gangwani; Azizullah Beran; Dushyant Singh Dahiya; Amir Humza Sohail; Wade Lee-Smith; Muhammad Aziz; Mona Hassan

doi:10.1016/j.amjms.2023.06.014

Nosocomial vs healthcare associated vs community acquired spontaneous bacterial peritonitis: Network meta-analysis

Am J Med Sci. 2023 Oct;366(4):305-313. doi: 10.1016/j.amjms.2023.06.014. Epub 2023 Jun 30.

Authors

Amna Iqbal¹, Manesh Kumar Gangwani², Azizullah Beran³, Dushyant Singh Dahiya⁴, Amir Humza Sohail⁵, Wade Lee-Smith⁶, Muhammad Aziz⁷, Mona Hassan⁷

Affiliations

¹ Department of Medicine, University of Toledo Medical Center, Toledo, Ohio, USA.
² Department of Medicine, University of Toledo Medical Center, Toledo, Ohio, USA. Electronic address: Gangwani.manesh@gmail.com.
³ Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indiana, USA.
⁴ Department of Medicine, Central Michigan University College of Medicine, MI, USA.
⁵ Department of General Surgery, New York University Langone Health, Long Island, NY,USA.
⁶ University of Toledo Libraries, University of Toledo, Toledo, Ohio, USA.
⁷ Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, USA.

PMID: 37394136
DOI: 10.1016/j.amjms.2023.06.014

Abstract

Introduction: Spontaneous bacterial peritonitis (SBP) is a common complication in decompensated liver cirrhosis with ascitic fluid polymorphonuclear cell count > 250/mm3. Community acquired SBP (CA-SBP) occurs within the first 48 hours after hospital admission. Nosocomial SBP (N-SBP) occurs 48-72 hours after hospitalization. Healthcare associated SBP (HA-SBP) occurs in patients hospitalized in the preceding 90 days to months. We aim to evaluate mortality and resistance patterns to third generation cephalosporin among the three types.

Methods: Multiple databases were systematically searched from inception through August 1^st, 2022. Both pairwise (direct) and network (direct + indirect) meta-analysis was performed using a random effects model and DerSimonian Laird approach. Relative Risk (RR) with 95% confidence intervals (CI) were calculated. Network meta-analysis was conducted using frequentist approach.

Results: A total of 14 studies with a total of 2302 SBP episodes were evaluated. On direct meta-analysis, mortality rate was higher in N-SBP compared to HA-SBP (RR 1.84, CI 1.43- 2.37) and CA-SBP (RR 1.69, CI 1.4-1.98), but not significantly different between HA-SBP and CA-SBP (RR=1.40, CI=0.71-2.76). Resistance to third generation cephalosporins was significantly higher in N-SBP compared to HA-SBP (RR=2.02, CI 1.26-3.22) and CA-SBP (RR=3.96, CI=2.50-3.60) as well as in HA-SBP compared to CA-SBP (RR=2.25, CI=1.33-3.81).

Conclusions: Our network meta-analysis shows increased mortality and antibiotic resistance with nosocomial SBP. We recommend clearly identifying such patients to manage accordingly as well as developing guidelines geared towards nosocomial infections to be able to optimally steer resistance patterns and reduce mortality.

Keywords: Alcoholic cirrhosis; Cirrhosis; NASH; Nosocomial; SBP; Spontaneous bacterial peritonitis.

Publication types

Meta-Analysis
Review

MeSH terms

Anti-Bacterial Agents / therapeutic use
Bacterial Infections* / complications
Bacterial Infections* / drug therapy
Cross Infection* / drug therapy
Cross Infection* / microbiology
Hospitals
Humans
Liver Cirrhosis / complications
Network Meta-Analysis
Peritonitis* / complications
Peritonitis* / drug therapy

Substances

Anti-Bacterial Agents