BACKGROUND: Spontaneous bacterial peritonitis (SBP) is historically caused by Gram-negative bacteria (GNB) almost exclusively Enterobacteriaceae. Recently, an increasing rate of infections with Gram-positive cocci (GPC) and multidrug-resistant (MDR) microorganisms was demonstrated. AIMS: To assess possible recent changes of the bacteria causing SBP in cirrhotic patients. METHODS: We retrospectively recorded 47 cases (66% males) during a 4-year-period (2008-2011). RESULTS: Twenty-eight (60%) patients had healthcare-associated infections while 15 (32%) received prophylactic quinolone treatment. GPC were found to be the most frequent cause (55%). The most prevalent organisms in a descending order were Streptococcus spp (n = 10), Enterococcus spp (n = 9), Escherichia coli (n = 8), Klebsiella pneumonia (n = 5), methicillin-sensitive Staphylococcus aureus (n = 4) and coagulase-negative Staphylococcus spp (n = 3). Nine of the isolated bacteria (19%) were MDR, including carbapenemase-producing K. pneumonia (n = 4), followed by extended-spectrum beta-lactamase-producing E. coli (n = 3) and Pseudomonas aeruginosa (n = 2). MDR bacteria were more frequently isolated in healthcare-associated than in community-acquired infections (100% vs 50%, P = 0.006), in patients receiving long-term quinolone prophylaxis (67% vs 24%, P = 0.013) and in those with advanced liver disease as suggested by higher MELD score (28 vs 19, P = 0.012). More infections with GNB than GPC were healthcare-associated (81% vs 42%, P = 0.007). Third-generation cephalosporin resistance was observed in 49% and quinolone resistance in 47%. CONCLUSIONS: GPC were the most frequent bacteria in culture-positive SBP and a variety of drug-resistant microorganisms have emerged. As a result of high rates of resistance in currently recommended therapy and prophylaxis, the choice of optimal antibiotic therapy is vital in the individual patient.
BACKGROUND: Spontaneous bacterial peritonitis (SBP) is historically caused by Gram-negative bacteria (GNB) almost exclusively Enterobacteriaceae. Recently, an increasing rate of infections with Gram-positive cocci (GPC) and multidrug-resistant (MDR) microorganisms was demonstrated. AIMS: To assess possible recent changes of the bacteria causing SBP in cirrhotic patients. METHODS: We retrospectively recorded 47 cases (66% males) during a 4-year-period (2008-2011). RESULTS: Twenty-eight (60%) patients had healthcare-associated infections while 15 (32%) received prophylactic quinolone treatment. GPC were found to be the most frequent cause (55%). The most prevalent organisms in a descending order were Streptococcus spp (n = 10), Enterococcus spp (n = 9), Escherichia coli (n = 8), Klebsiella pneumonia (n = 5), methicillin-sensitive Staphylococcus aureus (n = 4) and coagulase-negative Staphylococcus spp (n = 3). Nine of the isolated bacteria (19%) were MDR, including carbapenemase-producing K. pneumonia (n = 4), followed by extended-spectrum beta-lactamase-producing E. coli (n = 3) and Pseudomonas aeruginosa (n = 2). MDR bacteria were more frequently isolated in healthcare-associated than in community-acquired infections (100% vs 50%, P = 0.006), in patients receiving long-term quinolone prophylaxis (67% vs 24%, P = 0.013) and in those with advanced liver disease as suggested by higher MELD score (28 vs 19, P = 0.012). More infections with GNB than GPC were healthcare-associated (81% vs 42%, P = 0.007). Third-generation cephalosporin resistance was observed in 49% and quinolone resistance in 47%. CONCLUSIONS: GPC were the most frequent bacteria in culture-positive SBP and a variety of drug-resistant microorganisms have emerged. As a result of high rates of resistance in currently recommended therapy and prophylaxis, the choice of optimal antibiotic therapy is vital in the individual patient.
Authors: S Pouriki; G Vrioni; H Sambatakou; A Alexopoulou; L Vasilieva; I Mani; A Tsakris; S P Dourakis Journal: Eur J Clin Microbiol Infect Dis Date: 2017-09-30 Impact factor: 3.267
Authors: Jacqueline G O'Leary; K Rajender Reddy; Florence Wong; Patrick S Kamath; Heather M Patton; Scott W Biggins; Michael B Fallon; Guadalupe Garcia-Tsao; Ram M Subramanian; Raza Malik; Leroy R Thacker; Jasmohan S Bajaj Journal: Clin Gastroenterol Hepatol Date: 2014-08-12 Impact factor: 11.382
Authors: Min Jae Kim; Kyoung-Ho Song; Nak-Hyun Kim; Pyoeng Gyun Choe; Wan Beom Park; Ji Hwan Bang; Eu Suk Kim; Sang Won Park; Hong Bin Kim; Hyo-Suk Lee; Myoung-Don Oh; Nam Joong Kim Journal: Hepatol Int Date: 2014-06-08 Impact factor: 6.047