{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T13:50:26Z","timestamp":1787061026276,"version":"build-2736575974"},"reference-count":45,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,3,8]],"date-time":"2023-03-08T00:00:00Z","timestamp":1678233600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2023,6]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Patients with cirrhosis and treatment non\u2010responsive spontaneous bacterial peritonitis (SBP) have high mortality. We aimed to investigate whether GM\u2010CSF can improve SBP response rates.<\/jats:p>\n <\/jats:sec>\n \n Patients and Methods<\/jats:title>\n \n In this open\u2010label RCT, 131 cirrhosis patients with difficult\u2010to\u2010treat SBP (DTT SBP) were randomized to receive meropenem alone (1\u00a0g IV thrice daily for 5\u2009days) (MERO Group,\n n<\/jats:italic>\n \u00a0=\u00a066) or in combination with GM\u2010CSF (1.5 mcg\/Kg daily IV till resolution or till 5d) (MEROGM Group,\n n<\/jats:italic>\n \u00a0=\u00a065). The primary end\u2010point was SBP early\u2010response (reduction in absolute neutrophil count (ANC) by >25% after 48\u2009h). Secondary end\u2010points included SBP resolution at day 5.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Patients in MEROGM group in comparison to MERO group had higher SBP early\u2010response (60% vs. 31.8%;\n p<\/jats:italic>\n \u00a0=\u00a0.001) and SBP resolution rates (55.4% vs. 24.2%;\n p<\/jats:italic>\n \u00a0=\u00a0.0003). Patients in the combination arm also had better resolution of pneumonia {8\/17 (47.05%) vs. 2\/19 (10.5%),\n p<\/jats:italic>\n \u00a0=\u00a0.02} and lower incidence of new\u2010onset AKI (15.4% vs. 31.8%,\n p<\/jats:italic>\n \u00a0=\u00a0.02), HE (18.5% vs. 34.8%,\n p<\/jats:italic>\n \u00a0=\u00a0.04) and infections (21.5% vs. 37.9%,\n p<\/jats:italic>\n \u00a0=\u00a0.05). In comparison to MERO group, 7\u2010day survival was higher in MEROGM group (89.2% vs. 78.7%,\n p<\/jats:italic>\n \u00a0=\u00a0.03), though the 28\u2010day survival was comparable (78.4% vs. 71.2%;\n p<\/jats:italic>\n \u00a0=\u00a0.66). None of the patients developed treatment\u2010related severe adverse effects requiring discontinuation of therapy.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The addition of GM\u2010CSF to meropenem significantly improves response rates in DTT SBP patients within 48\u2009h. Early use of GMCSF modulates host immune response, and enhances antibiotic response with higher SBP resolution. The use of GMCSF needs to be considered in combating difficult SBP in cirrhosis patients.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/liv.15534","type":"journal-article","created":{"date-parts":[[2023,2,7]],"date-time":"2023-02-07T02:05:07Z","timestamp":1675735507000},"page":"1298-1306","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Combination of GM CSF and carbapenem is superior to carbapenem monotherapy in difficult\u2010to\u2010treat spontaneous bacterial peritonitis: A randomized controlled trial"],"prefix":"10.1111","volume":"43","author":[{"given":"Vikash","family":"Prakash","sequence":"first","affiliation":[{"name":"Department of Hepatology Institute of Liver and Biliary Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinod","family":"Arora","sequence":"additional","affiliation":[{"name":"Department of Hepatology Institute of Liver and Biliary Sciences New Delhi 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