{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T02:00:09Z","timestamp":1785463209044,"version":"3.56.0"},"reference-count":24,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"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":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>The rising burden of multidrug\u2010resistant (MDRO) and carbapenem\u2010resistant organisms (CRO) among patients with cirrhosis and spontaneous bacterial peritonitis (SBP) is compromising the effectiveness of standard empiric therapy. This multicentre study evaluated resistance patterns, independent predictors of MDRO and CRO infection, and clinical outcomes to inform risk\u2010based empiric therapy and antimicrobial stewardship in ascitic infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We analysed clinical characteristics and outcomes of hospitalized patients with cirrhosis and culture\u2010positive ascitic fluid infections from 13 centres across India. SBP was defined as ascitic neutrophil count (ANC) \u2265\u2009250\/mm\n                      <jats:sup>3<\/jats:sup>\n                      ; culture\u2010positive cases with ANC &lt;\u2009250\/mm\n                      <jats:sup>3<\/jats:sup>\n                      were classified as non\u2010neutrocytic bacterascites (NNBA). Predictors of MDRO, CRO and mortality were assessed through regression models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 319 patients (median age 49\u2009years; 79.9% male; 65.8% with acute\u2010on\u2010chronic liver failure), 74.6% of isolates were gram\u2010negative. MDRO and CRO were identified in 53.6% and 24.1% of infections, respectively. Nosocomial\/healthcare\u2010associated acquisition, circulatory failure, elevated leukocyte count and SBP prophylaxis were independently associated with MDRO infection, while the nosocomial setting, leukocyte count and circulatory failure predicted CRO infection. MDRO infection was associated with poorer survival. Respiratory failure, liver failure, systemic inflammation, presence of MDRO and higher ACLF severity independently predicted mortality. Nearly one\u2010third of culture\u2010positive infections had ANC &lt;\u2009250\/mm\n                      <jats:sup>3<\/jats:sup>\n                      yet showed similar mortality to SBP. Based on clinical setting and risk profile, an empiric treatment framework was proposed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There is a high burden of MDRO and CRO in ascitic infections among hospitalized patients with cirrhosis, with clinically relevant impact on outcomes. Empiric antibiotic selection should be guided by acquisition setting, illness severity and resistance risk factors, with stewardship oversight. Similar outcomes between NNBA and SBP suggest that microbiological evidence, rather than neutrophil count alone, should guide decisions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apt.70716","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T03:06:21Z","timestamp":1778727981000},"page":"479-498","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Epidemiology, Predictors of Antimicrobial Resistance and Empiric Treatment Strategies for Spontaneous Bacterial Peritonitis in Cirrhosis: A Multicentre\n                    <scp>SBP<\/scp>\n                    \u2010\n                    <scp>INDIA<\/scp>\n                    Study"],"prefix":"10.1111","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4328-0914","authenticated-orcid":false,"given":"Nipun","family":"Verma","sequence":"first","affiliation":[{"name":"Department of Hepatology PGIMER  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0007-0063","authenticated-orcid":false,"given":"Rohit","family":"Mehtani","sequence":"additional","affiliation":[{"name":"Department of Hepatology Amrita School of Medicine, Amrita Vishvavidyapeetham  Faridabad Haryana India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arun","family":"Valsan","sequence":"additional","affiliation":[{"name":"Department of Hepatology Amrita Institute of Medical Sciences  Kochi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pratibha","family":"Garg","sequence":"additional","affiliation":[{"name":"Department of Hepatology PGIMER  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohit Kumar","family":"Nadda","sequence":"additional","affiliation":[{"name":"Department of Hepatology PGIMER  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shilpa","family":"Prasad","sequence":"additional","affiliation":[{"name":"Department of Hepatology Amrita Institute of Medical Sciences  Kochi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9841-8768","authenticated-orcid":false,"given":"Anand","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology AIIMS  Rishikesh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6641-2505","authenticated-orcid":false,"given":"Rohit","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology AIIMS  Rishikesh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balram Ji","family":"Omar","sequence":"additional","affiliation":[{"name":"Department of Microbiology AIIMS  Rishikesh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naga Srikanth","family":"Darla","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology AIIMS  Rishikesh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5265-2586","authenticated-orcid":false,"given":"Roshan","family":"Agarwala","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Apollo Hospitals  Guwahati India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mrinal Deb","family":"Barma","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Apollo Hospitals  Guwahati India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandira","family":"Sarma","sequence":"additional","affiliation":[{"name":"Department of Microbiology Apollo Hospitals  Guwahati India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ameet","family":"Mandot","sequence":"additional","affiliation":[{"name":"Department of Hepatology Gleneagles Hospital  Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wasim","family":"Khot","sequence":"additional","affiliation":[{"name":"Department of Hepatology Gleneagles Hospital  Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Shalimar","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Human Nutrition AIIMS  Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akash","family":"Shukla","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology KEM Hospital  Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arun","family":"Vaidya","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology KEM Hospital  Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mithra","family":"Prasad","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology VGM Hospital  Coimbatore India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dibyalochan","family":"Praharaj","sequence":"additional","affiliation":[{"name":"Department of Hepatology KIMS  Bhubaneshwar India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil C.","family":"Anand","sequence":"additional","affiliation":[{"name":"Department of Hepatology KIMS  Bhubaneshwar India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radha Krishan","family":"Dhiman","sequence":"additional","affiliation":[{"name":"Department of Hepatology SGPGI  Lucknow India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0402-5534","authenticated-orcid":false,"given":"Surender","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Hepatology SGPGI  Lucknow India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narendra Singh","family":"Choudhary","sequence":"additional","affiliation":[{"name":"Department of Hepatology and Regenerative Medicine Medanta Hospital  Gurgaon India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand","family":"Kulkarni","sequence":"additional","affiliation":[{"name":"Department of Hepatology AIG  Hyderabad India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandeep","family":"Satsangi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Apollo Hospitals  Bangalore India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahaj","family":"Rathi","sequence":"additional","affiliation":[{"name":"Department of Hepatology PGIMER  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8567-1676","authenticated-orcid":false,"given":"Arka","family":"De","sequence":"additional","affiliation":[{"name":"Department of Hepatology PGIMER  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2961-4148","authenticated-orcid":false,"given":"Madhumita","family":"Premkumar","sequence":"additional","affiliation":[{"name":"Department of Hepatology PGIMER  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil","family":"Taneja","sequence":"additional","affiliation":[{"name":"Department of Hepatology PGIMER  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virendra","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Hepatology PGIMER  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Archana","family":"Angrup","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology PGIMER  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neelam","family":"Taneja","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology PGIMER  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nusrat","family":"Shafiq","sequence":"additional","affiliation":[{"name":"Department of Pharmacology PGIMER  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Duseja","sequence":"additional","affiliation":[{"name":"Department of Hepatology PGIMER  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.12.005"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.03.024"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2026.02.007"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2025.07.034"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27941"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.4254\/wjh.v16.i11.1265"},{"key":"e_1_2_8_8_1","volume-title":"CLSI. Methods for Dilution Antimicrobial Suscetibility Tests for Bactria That Grow Aerobically","author":"Zimmer B. L.","year":"2024"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072\u2010023\u201010536\u20107"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.02.042"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/eci.12701"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469\u20100691.2011.03570.x"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.13438"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840210312"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s005350200006"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.06.046"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciae403"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004836\u2010200110000\u201000007"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2003.50119"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aohep.2019.07.010"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.7860\/JCDR\/2019\/42606.13344"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jceh.2024.101352"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000003075"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jceh.2021.08.010"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/LVT.0000000000000068"}],"container-title":["Alimentary Pharmacology &amp; Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.70716","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/apt.70716","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.70716","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T01:34:25Z","timestamp":1785461665000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apt.70716"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":24,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/apt.70716"],"URL":"https:\/\/doi.org\/10.1111\/apt.70716","archive":["Portico"],"relation":{},"ISSN":["0269-2813","1365-2036"],"issn-type":[{"value":"0269-2813","type":"print"},{"value":"1365-2036","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]},"assertion":[{"value":"2026-01-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}