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Enterococcus: not an innocent bystander in cirrhotic patients with spontaneous bacterial peritonitis

Cited 14 time in Web of Science Cited 16 time in Scopus
Authors
Lee, J-H; Yoon, J-H; Kim, B H; Chung, G E; Myung, S J; Kim, W; Kim, Y J; Kim, E-C; Lee, H-S
Issue Date
2008-07-10
Publisher
Springer Verlag
Citation
Eur J Clin Microbiol Infect Dis. 2009 Jan;28(1):21-6. Epub 2008 Jul 9.
Keywords
AgedAmpicillin/pharmacologyAnti-Bacterial Agents/pharmacology/therapeutic useAscites/microbiologyCephalosporins/therapeutic useCohort StudiesEnterococcus/*isolation & purificationFemaleGentamicins/pharmacologyGram-Positive Bacterial Infections/drug therapy/*microbiology/mortality/physiopathologyHumansKoreaLiver Cirrhosis/*complicationsMaleMicrobial Sensitivity TestsMiddle AgedPeritonitis/drug therapy/*microbiology/mortality/physiopathologyRetrospective StudiesTreatment OutcomeVancomycin/pharmacology
Abstract
Clinicians sometimes experience treatment failure in the initial empirical antibiotics treatment using cephalosporins in cirrhotic patients with spontaneous bacterial peritonitis (SBP). Enterococcus, which is intrinsically resistant to cephalosporins, may be one of the causes of treatment failure. The aim of this study was to evaluate the clinical importance and the clinical characteristics of spontaneous enterococcal peritonitis (SEP). This was a retrospective cohort study of 359 patients with SBP treated in a single tertiary care center in South Korea from January 2000 through December 2004. We evaluated the clinical manifestation and the treatment results of SBP patients with enterococci identified from ascites culture. During the observation period, 13 of 359 patients (3.6%) diagnosed with culture-positive SBP had enterococcal peritonitis. For the initial empirical treatment, third-generation cephalosporins were administered to the 13 patients, ten of whom (76.9%) did not improve in the first 48 h. An in vitro antibiotic sensitivity test showed that the identified enterococci were susceptible to ampicillin plus gentamycin in eight patients (61.5%) and there was no vancomycin-resistant enterococcus. Although antibiotics were changed to antienterococcal antibiotics in 11 patients, only five patients improved. As a result, eight of the 13 patients (61.5%) with enterococcal SBP died during the observation period, and the one-month mortality was significantly higher from enterococcal SBP than from nonenterococcal SBP (P = 0.038). We conclude that enterococcal SBP has poor prognosis and it is reasonable to use antienterococcal antibiotics when enterococcus is identified from ascites culture of patients with liver cirrhosis.
ISSN
1435-4373 (Electronic)
Language
English
URI
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18612666

http://www.springerlink.com/content/qn3rw4351503r314/fulltext.pdf

https://hdl.handle.net/10371/46692
DOI
https://doi.org/10.1007/s10096-008-0578-3
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College of Medicine/School of Medicine (의과대학/대학원)Internal Medicine (내과학전공)Journal Papers (저널논문_내과학전공)
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