@article{3158405,
    title = "Increasing frequency of gram-positive cocci and gram-negative
multidrug-resistant bacteria in spontaneous bacterial peritonitis",
    author = "Alexopoulou, Alexandra and Papadopoulos, Nikolaos and Eliopoulos, and Dimitrios G. and Alexaki, Apostolia and Tsiriga, Athanasia and Toutouza, and Marina and Pectasides, Dimitrios",
    journal = "Liver International",
    year = "2013",
    volume = "33",
    number = "7",
    pages = "975-981",
    publisher = "Wiley-Blackwell",
    issn = "1478-3223, 1478-3231",
    doi = "10.1111/liv.12152",
    keywords = "carbapamenase-producing K. pneumonia; ESBL-producing E. coli;
multidrug-resistant bacteria; quinolone resistance; spontaneous
bacterial peritonitis; third-generation cephalosporin resistance",
    abstract = "<sec id=”liv12152-sec-0001”> BackgroundSpontaneous 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.
<sec id=”liv12152-sec-0002”> AimsTo assess possible recent changes
of the bacteria causing SBP in cirrhotic patients.
<sec id=”liv12152-sec-0003”> MethodsWe retrospectively recorded 47
cases (66% males) during a 4-year-period (2008-2011).
<sec id=”liv12152-sec-0004”> ResultsTwenty-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%.
<sec id=”liv12152-sec-0005”> ConclusionsGPC 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."
}