A Recent Evaluation of Empirical Cephalosporin Treatment and Antibiotic Resistance of Changing Bacterial Profiles in Spontaneous Bacterial Peritonitis

• Published in: Digestive diseases and sciences Vol. 55; no. 4; pp. 1149 - 1154
• Main Authors: Yakar, Tolga, Güçlü, Mustafa, Serin, Ender, Alışkan, Hikmet
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.04.2010; Springer; Springer Nature B.V
• Subjects: Abdomen; Adult; Aged; Aged, 80 and over; Analysis; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Ascitic Fluid - microbiology; Bacteria; Bacterial Infections - drug therapy; Bacterial Infections - microbiology; Biochemistry; Biological and medical sciences; Care and treatment; Cefotaxime - therapeutic use; Cephalosporins - therapeutic use; Drug resistance in microorganisms; Drug Resistance, Bacterial; Enterococcus - drug effects; Escherichia coli; Escherichia coli Infections - drug therapy; Escherichia coli Infections - microbiology; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Health aspects; Hepatology; Humans; Infusions, Intravenous; Klebsiella Infections - drug therapy; Klebsiella Infections - microbiology; Klebsiella pneumoniae - drug effects; Leukocyte Count; Levofloxacin; Liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - microbiology; Male; Medical sciences; Medicine; Medicine & Public Health; Methicillin; Microbial Sensitivity Tests; Middle Aged; Neutrophils; Ofloxacin - therapeutic use; Oncology; Original Article; Other diseases. Semiology; Peritonitis; Peritonitis - drug therapy; Peritonitis - microbiology; Pharmacology. Drug treatments; Pneumococcal Infections - drug therapy; Pseudomonas aeruginosa - drug effects; Pseudomonas Infections - drug therapy; Staphylococcal Infections - drug therapy; Staphylococcal Infections - microbiology; Staphylococcus; Transplant Surgery; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Microbiology; Ascites; Levofloxacin; Treatment resistance; Effusion; β-Lactams; Escherichia coli; Spontaneous; Metabolic diseases; Infection; Fluoroquinolone derivatives; Antibiotic; Cephalosporin derivatives; Abdominal disease; Gastroenterology; Bacteriosis; Bacteria; Antibacterial agent; Quinolone derivatives; Peritonitis; Enterobacteriaceae
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-009-0825-1

The aim of this research is to evaluate the recent changes in microorganisms causing spontaneous bacterial peritonitis in cirrhotic patients, antibiotic resistance, and response to empirical cephalosporin therapy. A total of 218 patients with ascites secondary to cirrhosis were enrolled. Parenteral cefotaxime or cefepime was given to patients who had a neutrophil count of 250/mm 3 or more or a positive bacterial culture of ascitic fluid. Antibiotic failure was defined by an absence of clinical improvement and an insufficient decrease in neutrophil count of ascites (<25% of initial value) by the third day of therapy. Of all the patients, 44.6% had culture-negative neutrocytic ascites, 24.8% had spontaneous bacterial peritonitis, and 10.1% had monomicrobial nonneutrocytic bacterascites. Growth in culture was observed in 76 patients (34.9%). The two most common isolated bacteria were Escherichia coli (33.8%) and coagulase-negative Staphylococcus (CoNS; 19.7%). The two cephalosporins were effective against E. coli (82%) and but not against CoNS (44%), while levofloxacin showed reasonable activity against both E. coli (71%) and CoNS (90%) in vitro. We confirmed a recent increased incidence of spontaneous bacterial peritonitis caused by Gram-positive bacteria. Levofloxacin seems to be a good alternative treatment for patients with uncomplicated spontaneous ascites infections.