For spontaneous bacterial peritonitis (SBP) with low risk of multidrug-resistant organisms, empiric therapy with piperacillin/tazobactam (TZP) has been recommended in guidelines. Researchers herein examined the clinical benefit of coverage of beta-lactam-resistant Gram-positive bacteria, such as ampicillin-resistant Enterococcus faecium, in such situations.

• Observational study involving the investigation of the real-world effectiveness of empirical therapy with TZP monotherapy vs TZP plus linezolid (LZD) combination therapy in SBP.

• The first cohort had occurrences of 100 SBP episodes that were empirically treated with TZP+LZD combination therapy (n = 50) or PTZ monotherapy (n = 50); there were treatment failures (defined as the need to escalate antibiotic therapy due to in vitro resistance, lack of neutrophil decrease in ascitic fluid, or clinical decision, and 30-day survival) in 48% with TZP monotherapy vs 16% with TZP+LZD combination therapy.

• The second cohort of 41 patients received empirical treatment with TZP; 37% had an occurrence of treatment failure, which was also higher than in episodes treated with TZP+LZD in cohort 1.

• Overall, there were fewer treatment failures in correlation with providing empirical TZP+LZD combination therapy with no impact on short-term survival of patients with SBP.