Background: Spontaneous bacterial peritonitis (SBP) is the most prevalent bacterial infection in patients with cirrhosis.  Cefotaxim has been considered the first choice of empirical antibiotic for the treatment of SBP. Studies from different parts of world have reported significant rates of resistance to third-generation cephalosporins. Patients not responding to 3rd generation cephalosporins require longer duration of treatment with higher spectrum antibiotics which will prolong the hospital stay and more financial constrains for the patients

Objective: To find Factors predicting failure of 3rd generation cephalosporins in treatment of SBP in decompensated cirrhosis patients

Methods: Retrospective Observational study by data collection of all patients admitted with cirrhosis and SBP who were started on cefotaxim from januvary 2015 to  januvary 2016 in  department of medical gastroenterology govt medical college Trivandrum  were done. Multivariate logistic regression was used to determine independent predictors of third-generation cephalosporin resistance

Results: 168 patients met the criteria for study inclusion. 120 (71.42%) patients responded to cephalosporin therapy.  48 (28.57%) were non responders. Alcoholic liver disease 113(67%), NASH 36 (21%), Hep B infection 26 (15%) were predominant cause of decompensated cirrhosis. 58(48.3%) responders and 22 (44%) non responders were on norflox prophylaxis. H/o recent broad spectrum antibiotic usage was found in 24 (20%) responders and 17(35.41%) non responders. On multivariate analysis MELD >19 p0.001, OR 4.37 (95% CI 2.12-9.00), presence of hepatic encephalopathy p0.014, OR 2.53 (95% CI 1.2-5.3) and recent antibiotic usage p 0.01, OR 2.44 (95% CI 1.365-5.854) emerged as significant risk factor for resistance to 3^rd generation cephalosporins

Conclusion: High MELD score, presence of encephalopthy and recent broad spectrum antibiotic usage emerged as significant risk factor for resistance to 3^rd generation cephalosporins. These group of patients with SBP should receive empirical treatment with higher antibiotics during admission

Keywords: SBP, Cefotaxim, Response.

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Ramu Muraleedharanpillai

Senior Resident, Dept of Medical Gastroenterology,

Govt Medical College, Trivandrum, 695011

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