Current etiology and carbapenem resistance of bacteria causing spontaneous bacterial peritonitis: a systematic review

Spontaneous Bacterial Peritonitis (SBP) has traditionally been associated with Gram-negative Enterobacteriaceae. However, recent studies indicate a shift in the epidemi-ology, with Gram-positive bacteria now identified as major pathogens responsible for SBP. Furthermore, there is an increasing prevalence of bacteria resistant to carbapenems. Based on these developments, this systematic review aims to explore the epidemiology of SBP since the first report of Carbapenem-Resistant Enterobacterales (CRE) in 2012. This systematic review protocol was prospectively registered in PROSPERO (CRD42020173786). A comprehensive literature search was conducted, incorporating data available until 29 October 2023, from MEDLINE via PubMed, EMBASE and CENTRAL databases. A total of 1647 records were identified (EMBASE: 885; PubMed: 730; Cochrane: 32), among which 21 studies met the inclusion criteria for this review. In total, 2943 pathogens were isolated across these studies, and among them, 561 (19.02%) were identified as multidrug-resistant organisms (MDROs), resulting in an overall prevalence of MDROs of approximately one-fifth. Furthermore, a significant proportion of the isolates, specifically 1394 (47.27%), were classified as Gram-negative bacteria. Within this Gram-negative subset, 139 (9.97%) isolates exhibited resistance to carbapenem antibiotics, representing about one-tenth of the total. The data obtained from this systematic review indicate that Gram-negative bacteria account for slightly less than half of the isolates causing SBP. Within the Gram-negative category, approximately one-tenth of the isolates are resistant to carbapenems. Furthermore, the overall prevalence of MDROs responsible for SBP is about one-fifth of the isolates. These findings highlight the need for current guidelines on the empirical treatment of SBP to consider the prevailing etiology.

Carbapenem resistance; Carbapenem-resistant enterobacterales; Multidrug resistance; β-lactamase inhibitors; Anti-infective agents; Spontaneous bacterial peritonitis; Sepsis; Infection; Systematic review

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