{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T15:00:53Z","timestamp":1787583653613,"version":"build-2736575974"},"reference-count":20,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2026,6]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Proton pump inhibitor (PPI) treatment leads to significant changes in the gut microbiota composition. We hypothesized that these alterations may transfer into distinct changes in the causative agents of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis.<\/jats:p>\n <\/jats:sec>\n \n Aims<\/jats:title>\n To investigate the impact of PPI treatment on the pathogen spectrum of SBP.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A total of 227 cirrhosis patients with culture\u2010positive SBP from two German tertiary care centers were included and the pathogen spectrum of SBP was analysed with respect to PPI treatment.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n In the PPI\u2010group, gram\u2010positive bacteria were significantly more common compared to the non\u2010PPI\u2010group (62.1% vs. 34.0%,\n p<\/jats:italic>\n \u2009<\u20090.001). This involved increased abundances of\n Enterococcus<\/jats:italic>\n spp. (22.0% vs. 8.0%),\n Streptococcus<\/jats:italic>\n spp. (14.7% vs. 6.0%) and\n \n Staphylococcus aureus<\/jats:italic>\n <\/jats:styled-content>\n (15.8% vs. 8.0%). Importantly, more than half of the\n Enterococcus<\/jats:italic>\n isolates were susceptible only to antibiotics with extended gram\u2010positive activity. Conversely, gram\u2010negative bacteria were significantly more frequent in the non\u2010PPI\u2010group compared to the PPI\u2010group (64.0% vs. 40.7%,\n p<\/jats:italic>\n \u2009=\u20090.003), primarily due to a higher prevalence of\n \n E. coli<\/jats:italic>\n <\/jats:styled-content>\n (40.0% vs. 20.3%). In uni\u2010 and multivariable logistic regression analyses, PPI use was an independent predictor of gram\u2010positive SBP (OR 2.719, 95% CI 1.343\u20135.506,\n p<\/jats:italic>\n \u2009=\u20090.005), adjusted for nosocomial infection (OR 2.609, 95% CI 1.464\u20134.650,\n p<\/jats:italic>\n \u2009=\u20090.001) and Child\u2010Pugh score (OR 0.684, 0.552\u20130.848,\n p<\/jats:italic>\n \u2009<\u20090.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n PPI treatment is associated with increased abundances of gram\u2010positive pathogens, including\n Enterococcus<\/jats:italic>\n spp., in culture\u2010positive SBP. This result can help guide empiric antibiotic therapy of SBP.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/apt.70593","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T07:16:17Z","timestamp":1771398977000},"page":"1487-1494","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Altered Pathogen Spectrum of Spontaneous Bacterial Peritonitis in Patients Treated With Proton Pump Inhibitors"],"prefix":"10.1111","volume":"63","author":[{"given":"Philip","family":"Kitchen","sequence":"first","affiliation":[{"name":"Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah L.","family":"Sch\u00fctte","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology Hannover Medical School Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3908-6297","authenticated-orcid":false,"given":"Tammo L.","family":"Tergast","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology Hannover Medical School Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Maasoumy","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology Hannover Medical School Hannover Germany"},{"name":"German Center for Infection Research (DZIF) Hannover\/Braunschweig Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonie","family":"Braun","sequence":"additional","affiliation":[{"name":"Institute for Medical Microbiology and Hygiene, Medical Center University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich vor dem","family":"Esche","sequence":"additional","affiliation":[{"name":"Institute for Medical Microbiology and Hygiene, Medical Center University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"H\u00e4cker","sequence":"additional","affiliation":[{"name":"Institute for Medical Microbiology and Hygiene, Medical Center University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus M.","family":"M\u00fccke","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, University Hospital Goethe\u2010University Frankfurt Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlene","family":"Reincke","sequence":"additional","affiliation":[{"name":"Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Schultheiss","sequence":"additional","affiliation":[{"name":"Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany"},{"name":"Berta\u2010Ottenstein\u2010Programme, Faculty of Medicine University of Freiburg Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Thimme","sequence":"additional","affiliation":[{"name":"Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siegbert","family":"Rieg","sequence":"additional","affiliation":[{"name":"Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8782-8729","authenticated-orcid":false,"given":"Dominik","family":"Bettinger","sequence":"additional","affiliation":[{"name":"Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Sturm","sequence":"additional","affiliation":[{"name":"Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.06.013"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000001251"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2015-310376"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2015.06.043"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.15604"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.13568"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28737"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2009.80"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.03.024"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31884"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2008.04.026"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.42.8.3747-3751.2004"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1086\/340617"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.13862"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2022.03.052"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/HC9.0000000000000655"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.11.013"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2013.12.019"},{"key":"e_1_2_13_20_1","first-page":"e00492","article-title":"Proton 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