{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T02:59:35Z","timestamp":1789095575476,"version":"build-2803163510"},"reference-count":41,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2015,11,21]],"date-time":"2015-11-21T00:00:00Z","timestamp":1448064000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background &amp; Aims<\/jats:title><jats:p>Spontaneous bacterial peritonitis (<jats:styled-content style=\"fixed-case\">SBP<\/jats:styled-content>), in the presence of bacterial resistance or failure of third generation cephalosporins (3rd <jats:styled-content style=\"fixed-case\">GC<\/jats:styled-content>) has poor outcome. Empirical antibiotic(s) options are limited in these scenarios.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Consecutive cirrhotics with <jats:styled-content style=\"fixed-case\">SBP<\/jats:styled-content> because of hospital acquired <jats:styled-content style=\"fixed-case\">SBP<\/jats:styled-content> (&gt;48 h of admission), microbial resistance or non\u2010response (no resolution of <jats:styled-content style=\"fixed-case\">SBP<\/jats:styled-content> at 48 h) were randomized to Cefepime (<jats:italic>n<\/jats:italic> = 88) or Imipenem (<jats:italic>n<\/jats:italic> = 87) plus standard medical therapy. We assessed for \u2018response at 48 h\u2019 (reduction in ascitic fluid absolute neutrophil count (<jats:styled-content style=\"fixed-case\">ANC<\/jats:styled-content>) by &gt;25% at 48 h), resolution of <jats:styled-content style=\"fixed-case\">SBP<\/jats:styled-content> (&lt;250 cu\/mm <jats:styled-content style=\"fixed-case\">ANC<\/jats:styled-content> at day 5) and their clinical outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 957 paracentesis in 1200 hospitalized cirrhotics, 253 (26.4%) had <jats:styled-content style=\"fixed-case\">SBP<\/jats:styled-content> and 175 (69.6%) were randomized. Baseline parameters were comparable in two groups. Response at 48 h (58.6% vs. 51.7%; <jats:italic>P<\/jats:italic> = 0.4) and resolution of <jats:styled-content style=\"fixed-case\">SBP<\/jats:styled-content> in those with response at 48 h were comparable with no difference in mortality at week 2, month 1 and 3. Patients with \u2018No response at 48 h\u2019 had higher mortality compared with responders (73.8% vs. 25%; <jats:italic>P<\/jats:italic> &lt; 0.001). Resolution of <jats:styled-content style=\"fixed-case\">SBP<\/jats:styled-content> was associated with \u2018response at 48 h\u2019 and septic shock, latter being main pre\u2010terminal event. <jats:styled-content style=\"fixed-case\">AKI<\/jats:styled-content> at enrolment [Hazard ratio (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>), 2.6], pneumonia [<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>, 2.9], septic shock [<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>, 2.2] and response at 48 h [<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>, 4.6] predicted poor outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In hospitalized cirrhotics with <jats:styled-content style=\"fixed-case\">SBP<\/jats:styled-content> and risk factors for treatment failure, cefepime showed comparable efficacy and survival to imipenem. Non\u2010response to therapy at 48 h is a reliable predictor of treatment failure and mortality. Antibiotic combinations and novel options are needed for these patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.12985","type":"journal-article","created":{"date-parts":[[2015,10,16]],"date-time":"2015-10-16T15:14:42Z","timestamp":1445008482000},"page":"677-687","source":"Crossref","is-referenced-by-count":14,"title":["A randomized open label study of \u2018imipenem vs. cefepime\u2019 in spontaneous bacterial peritonitis"],"prefix":"10.1111","volume":"36","author":[{"given":"Ankur","family":"Jindal","sequence":"first","affiliation":[{"name":"Department of Hepatology Institute of Liver &amp; Biliary Sciences (ILBS) New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoj","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Hepatology Institute of Liver &amp; Biliary Sciences (ILBS) New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajeet 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