Bacterial infections in cirrhosis: Epidemiological changes... : Hepatology (original) (raw)

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Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis

Fernández, Javier1; Navasa, Miquel M.D.*,1; Gómez, Juliá2; Colmenero, Jordi1; Vila, Jordi2; Arroyo, Vicente1; Rodés, Juan1

1 Liver Unit, IMD,Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain

2 Department of Microbiology and IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona0, Spain

E-mail:[email protected]

*Address reprint requests to: Liver Unit, IMD, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain. fax: (34) 93 4515522

Received June 14, 2001; accepted October 01, 2001; previously published online December 30, 2003

Abstract

The extensive use of invasive procedures and of long-term norfloxacin prophylaxis in the management of cirrhotic patients may have influenced the epidemiology of bacterial infections in cirrhosis. We conducted a prospective evaluation of all bacterial infections diagnosed in patients with cirrhosis in a Liver Unit between April 1998 and April 2000. A total of 405 patients presented 572 bacterial infections in 507 admissions. Spontaneous bacterial peritonitis was the most frequent infection (138 cases). Gram-positive cocci were responsible for 53% of total bacterial infections in the study, being the main bacteria isolated in nosocomial infections (59%). Patients requiring treatment in an intensive care unit and those submitted to invasive procedures presented a higher rate of infections caused by gram-positive cocci (77% vs. 48%, P < .001 and 58% vs. 40%, P < .02, respectively). Fifty percent of culture-positive spontaneous bacterial peritonitis in patients on long-term norfloxacin administration (n = 93) and 16% in patients not receiving this therapy (n = 414) were caused by quinolone-resistant gram-negative bacilli, P = .01. The rate of culture-positive spontaneous bacterial peritonitis caused by trimethoprim-sulfamethoxazole-resistant gram-negative bacilli was also very high in patients on long-term norfloxacin administration (44% vs. 18%, P = .09). In conclusion, infections caused by gram-positive cocci have markedly increased in cirrhosis. This phenomenon may be related to the current high degree of instrumentation of cirrhotic patients. Quinolone-resistant spontaneous bacterial peritonitis constitutes an emergent problem in patients on long-term norfloxacin prophylaxis, with trimethoprim-sulfamethoxazole not being a valid alternative.