Changing pattern of microorganisms and antibiotic resistance rate of spontaneous bacterial peritonitis: A 12-year experience.
- Author:
Moon Kyung JOO
1
;
Jong Eun YEON
;
Sun Jae LEE
;
Sang Jun SUH
;
Young Kul JUNG
;
Jeong Han KIM
;
Ji Hoon KIM
;
Hyung Joon YIM
;
Kwan Soo BYUN
Author Information
1. Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea. je_yeon@hotmail.com
- Publication Type:Original Article
- Keywords:
Liver cirrhosis;
Peritonitis;
Microorganism;
Drug Resistance, Bacteria
- MeSH:
Ampicillin;
Anti-Bacterial Agents;
Ascites;
Cefotaxime;
Ciprofloxacin;
Drug Resistance, Microbial;
Hospital Mortality;
Humans;
Incidence;
Liver Cirrhosis;
Multivariate Analysis;
Peritonitis;
Prognosis;
Retrospective Studies
- From:Korean Journal of Medicine
2008;75(1):68-76
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND/AIMS: Recently, the prognosis for spontaneous bacterial peritonitis (SBP) has improved; however, the causative microorganisms and antibiotic resistance rates are changing. We evaluated the changing pattern of causative agents and antibiotic resistance rates of SBP over a 12-year period. METHODS: We retrospectively analyzed 113 patients who were diagnosed with SBP and in whom ascites cultures were positive between 1996 and 2007. The 12-year period was subdivided into 6-year terms (period A, 1996~2001; and period B, 2002~2007). RESULTS: One hundred thirteen of 410 cases of SPB had positive ascites cultures. Thirty-seven cases were from period A and 76 cases were from period B. Hospital-acquired SBP was more common during period B. Gram negative microorganisms were isolated from 78% of SBP cases, and the most common microorganism was E.coli (60%). The resistance rates for ampicillin and ciprofloxacin were similar between the two periods, but resistance to cefotaxime was more frequent in period B (3% vs. 26%, p=0.002), and ESBL-producing E.coli was only cultured in period B (0% vs. 32%, p=0.002). Most of the initial antibiotics used were cefotaxime; carbapenem was used as a secondary antibiotic only in period B (0% vs. 55%, p=0.007). ESBL-producing microorganisms were the only predictor of in-hospital mortality based multivariate analysis (OR: 4.14, 95% CI: 1.09-15.07, p=0.037). CONCLUSIONS: No change in pattern of microorganisms in the ascites of patients with SBP was noted during the 12-year period under study, but there was a significant increase in the incidence of hospital-acquired SBP, resistance to cefotaxime, and ESBL-producing E.coli when comparing the outcomes of periods A and B. ESBL-producing microorganisms were the only predictor of in-hospital mortality.
