Clinical significance and outcome of nosocomial acquisition of spontaneous bacterial peritonitis in patients with liver cirrhosis.

Abstract

BACKGROUND:

There have been few reports on the causes and treatment outcomes for nosocomial spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis.

METHODS:

We performed a retrospective cohort study to compare the microbiological and clinical characteristics in nosocomial versus community-acquired SBP. All patients with SBP, for whom culture was proven to be positive for SBP at Samsung Medical Center (Seoul, Republic of Korea) from 1 January 2000 through 31 June 2007, were included. Medical records and laboratory data were reviewed. Nosocomial SBP was defined as SBP diagnosed after 72 h of hospitalization.

RESULTS:

A total of 236 patients with SBP were enrolled (mean age +/- SD age, 56.6 +/- 10.7 years); 166 patients were women, and 70 were men. Nosocomial and community-acquired SBP occurred in 126 and 110 patients, respectively. Escherichia coli accounted for 102 (43.2%) of 236 isolates, Klebsiella species accounted for 33 isolates (14.0%), and Streptococcus species accounted for 23 isolates (9.8%). The overall 30-day mortality rate for nosocomial SBP was higher than that for community-acquired SBP (58.7% vs. 37.3%; P = .001). Nosocomial isolates of gram-negative organisms were significantly more resistant to third-generation cephalosporins (41% vs. 10.0%; P = .001) and quinolones (50.0% vs. 30.9%; P = .003), compared with community-acquired isolates. Multivariate analysis revealed that nosocomial infection, concomitant hepatocellular carcinoma, presentation with acute renal failure or shock, and resistance to third-generation cephalosporins were significant risk factors for 30-day mortality associated with SBP.

CONCLUSIONS:

Nosocomial SBP has a poorer outcome than community-acquired SBP. The resistance to third-generation cephalosporins for gram-negative organisms, which are more common in nosocomial cases of SBP than in community-acquired cases of SBP, adversely affects the outcome of SBP in patients with liver cirrhosis.

• Authors: Hae Suk Cheong, Cheol-In Kang, Jeong A Lee, Soo Youn Moon, Mi Kyong Joung, Doo Ryeon Chung, Kwang Cheol Koh, Nam Yong Lee, Jae-Hoon Song, Kyong Ran Peck
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 48 Issue 9 Pg. 1230-6 (May 01 2009) ISSN: 1537-6591 [Electronic] United States
• PMID: 19302016 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Anti-Bacterial Agents

Topics

• Aged
• Anti-Bacterial Agents (pharmacology)
• Bacterial Infections (drug therapy, epidemiology, microbiology, mortality)
• Community-Acquired Infections (drug therapy, epidemiology, microbiology)
• Cross Infection (drug therapy, epidemiology, microbiology)
• Drug Resistance, Bacterial
• Escherichia coli (isolation & purification)
• Female
• Humans
• Klebsiella (isolation & purification)
• Korea (epidemiology)
• Liver Cirrhosis (complications)
• Male
• Middle Aged
• Peritonitis (drug therapy, epidemiology, microbiology, mortality)
• Retrospective Studies
• Streptococcus (isolation & purification)
• Treatment Outcome