Cefotaxime Is More Effective Than Is Ampicillin–Tobramycin in Cirrhotics With Severe Infections

Felisart, Josefina; Rimola, M D Antoni; Arroyo, Vicente; Pérez-Ayuso, Rosa María; Quintero, Enrique; Ginès, Pere; Rodés, Joan

doi:10.1002/hep.1840050319

Cited by 287 publications

(120 citation statements)

References 31 publications

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“…Já na década de 80, a maioria dos estudos demonstravam mortalidade em torno de 30% a 40% (12,15) , o que provavelmente era resultado do acréscimo no conhecimento e na precocidade diagnóstica desta infecção. A prática de se realizar paracentese rotineiramente, o alto índice de suspeita da infecção e a melhor clareza dos critérios diagnósticos resultaram na melhora do prognóstico desses pacientes.…”

Section: Discussionunclassified

Prevalência e prognóstico da peritonite bacteriana espontânea: experiência em pacientes internados em um hospital geral de Porto Alegre, RS, Brasil (1991-2000)

Coral

Mattos

Damo

et al. 2002

Arq. Gastroenterol.

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RESUMO -Racional -A peritonite bacteriana espontânea é complicação freqüente nos pacientes com cirrose e ascite, apresentando taxa de recurrência em 1 ano próxima de 70%. Objetivos -Avaliar a prevalência da peritonite bacteriana espontânea em pacientes com ascite por hepatopatia crônica e o impacto da sua presença na sobrevida dos mesmos. INTRODUÇÃOEstudos demonstram que 30% a 50% dos cirróticos apresentam infecções bacterianas na admissão hospitalar ou a desenvolvem durante a mesma (5,40) . Estas são responsáveis por até 25% das mortes nesta população de pacientes (5,28) .Dentre as infecções que acometem os pacientes com hepatopatia crônica, a de maior importância é a peritonite bacteriana espontânea (PBE) (5) .Entende-se por PBE a infecção do fluido de ascite sem haver um foco intra-abdominal aparente causal da infecção (15) .A PBE tem prevalência ao redor de 15% (1,5,18,44) , possuindo taxa de recurrência em 1 ano próxima de 70% (2,42) . Por outro lado, traz ao paciente cirrótico com ascite um empobrecimento no prognóstico tanto a curto, quanto a longo prazo, determinando mortalidade hospitalar, nos dias atuais, em torno de 20% (22,28,43) .Diante da escassez de estudos (5,14) que analisam a evolução dos pacientes com PBE em nosso País e também as diferenças regionais existentes, entende-se que esta infecção merece ser avaliada em nosso meio, com o intuito de observar seu comportamento nos dias atuais, permitindo assim, a busca de novas estratégias que visem melhorar seu prognóstico. Portanto, teve-se como objetivo principal, avaliar a prevalência da PBE e sua implicação na mortalidade hospitalar de pacientes com ascite secundária à hepatopatia crônica internados em um hospital geral.

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Section: Discussionunclassified

Prevalência e prognóstico da peritonite bacteriana espontânea: experiência em pacientes internados em um hospital geral de Porto Alegre, RS, Brasil (1991-2000)

Coral

Mattos

Damo

et al. 2002

Arq. Gastroenterol.

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“…SBP, spontaneous bacterial empyema, bacteremia, and urinary tract infections were empirically treated with third-generation cephalosporins, intravenous cefotaxime 2 g/8 hours or ceftriaxone 1 g/24 hours. 25,26 The remaining infections were treated according to conventional criteria. The antibiotic dosages were adjusted to renal function throughout the treatment period.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2002

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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 grampositive cocci (77% vs. 48%, P < .001 and 58% vs. 40%, P < .02, respectively). B acterial infection is one of the most important clinical problems in patients with decompensated cirrhosis. It is present at admission or develops during hospitalization in 20% to 60% of the patients. 1-8 On the other hand, it is a common cause of death. Most studies assessing the etiology and clinical types of bacterial infections in cirrhosis were performed in the 1980s. At that time, the most common infections were urinary tract infections, pneumonia, and spontaneous bacterial peritonitis (SBP); most infections were community acquired; and approximately 70% to 80% of the isolated organisms were gram-negative bacilli (GNB). 1-8 However, during the last decade practice in hepatology has considerably changed and this may have influenced the epidemiology of bacterial infections in liver diseases. Treatment of cirrhotic patients with severe complications in intensive care units has been generalized, particularly with the extension of the liver transplantation programs, and the invasive procedures used in this setting are frequently associated with iatrogenic complications including infections. 9 On the other hand, new invasive treatments have been developed and are extensively used for specific complications of cirrhosis, including variceal ligation, transjugular intrahepatic portosystemic shunt, and arterial embolization or percutaneous ablation of hepatocellular carcinoma. These treatments may be also associated with infections. Finally, long-term selective intestinal decontamination with norfloxacin, which was introduced in 1987, is now widely used for the primary and secondary prophylaxis of SBP and spontaneous bacteremia in cirrhosis. 10,11 Norfloxacin prevents infections caused by GNB but not those caused by gram-positive cocci (GPC). All these features may have changed the type and etiology of acute bacterial infections in cirrhosis. However, there is no study on this topic.Another relevant problem, which has not been adequately evaluated is the clinical relevance of infections caused by quinoloneresistant gram-negative bacilli (QR-GNB) in cirrhosis. It is well known that patients submitted to long-term selective intestinal deconta...

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“…Renal failure was considered when blood urea nitrogen or serum creatinine were higher than 30 mg/dL and 1.5 mg/dL, respectively. 43 Most patients with SBP or bacteremia were empirically treated with intravenous cefotaxime 1 g/6 hours, 8,44 oral ofloxacin 400 mg/12 hours, 45 or amoxicillin-clavulanic acid first intravenously 1 g-0.2 g every 8 hours, then orally 500 mg-125 mg every 8 hours when patient condition allowed. 46,47 Urinary tract infections were treated in the same way or with other oral quinolones, according to the severity of the infection.…”

Section: Methodsmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] In spite of the improvement in survival observed during the last decade in cirrhotic patients developing bacterial infections, usually spontaneous bacterial peritonitis (SBP), mortality still remains high. [8][9][10][11][12][13] In fact, it is considered that up to 25% of deaths in cirrhotic patients are related to bacterial infection. 7,14 The most frequent causative agents isolated in bacterial infections of cirrhotic patients are gram-negative bacteria of intestinal origin, mainly Escherichia coli.…”

mentioning

confidence: 99%

“…7,14 The most frequent causative agents isolated in bacterial infections of cirrhotic patients are gram-negative bacteria of intestinal origin, mainly Escherichia coli. [1][2][3][4][5][6][7][8][11][12][13][14] It has been suggested that the gut may be the source of the infections in these patients, 7,11,12 and the passage of viable bacteria from the gastrointestinal tract to extraintestinal sites (i.e., bacterial translocation) seems to be an important step in the pathogenesis of SBP and other bacterial infections in cirrhotic patients. [15][16][17] Selective intestinal decontamination consists of the inhibition of the gram-negative flora of the gut with preservation of anaerobic bacteria, and theoretically prevention of gut colonization by new potentially pathogenic bacteria.…”

mentioning

confidence: 99%

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Infections Caused By Escherichia Coli Resistant to Norfloxacin in Hospitalized Cirrhotic Patients

Ortiz¹,

Vila²,

Soriano³

et al. 1999

Hepatology

112

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Selective intestinal decontamination with norfloxacin is useful to prevent bacterial infections in several groups of cirrhotic patients at high risk of infection. However, the emergence of infections caused by Escherichia coli resistant to quinolones has recently been observed in cirrhotic patients undergoing prophylactic norfloxacin. Our aim is to determine the characteristics of the infections caused by E. coli resistant to norfloxacin in hospitalized cirrhotic patients. One hundred and six infections caused by E. coli in 99 hospitalized cirrhotic patients were analyzed and distributed into two groups: group I (n ‫؍‬ 67), infections caused by E. coli sensitive to norfloxacin, and group II (n ‫؍‬ 39), infections caused by E. coli resistant to norfloxacin. The clinical and analytical characteristics at diagnosis of the infection were similar in both groups. Previous prophylaxis with norfloxacin was more frequent in group II (15/67, 22.4% vs. 32/39, 82%, P F .0001), as a result of a higher number of patients submitted to continuous long-term prophylaxis in this group, whereas previous short-term prophylaxis was similar in both groups. Infections were more frequently nosocomial-acquired in group II than in group I (17/67, 25.3% vs. 20/39, 51.2%, P ‫؍‬ .01). The type of infections was similar in both groups: urinary tract infections 38 in group I and 24 in group II, spontaneous bacterial peritonitis 8 and 2, spontaneous bacteremia 4 and 4, and bacterascites 1 and 0, respectively (pNS). Mortality during hospitalization was similar in the two groups (4/67, 5.9% vs. 5/39, 12.8%, pNS). None of the E. coli resistant to norfloxacin were also resistant to cefotaxime and only one of them was resistant to amoxicillin-clavulanic acid. Prophylaxis with norfloxacin, usually continuous long-term prophylaxis, favors the development of infections caused by norfloxacin-resistant E. coli. Long-term antibiotic prophylaxis should therefore be restricted to highly selected groups of cirrhotic patients at high-risk of infection. Infections caused by E. coli resistant to norfloxacin show a severity similar to those caused by sensitive E. coli. No significant associated resistance between norfloxacin and the antibiotics most frequently used in the treatment of bacterial infections in cirrhotic patients has been observed.

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Cefotaxime Is More Effective Than Is Ampicillin–Tobramycin in Cirrhotics With Severe Infections

Cited by 287 publications

References 31 publications

Prevalência e prognóstico da peritonite bacteriana espontânea: experiência em pacientes internados em um hospital geral de Porto Alegre, RS, Brasil (1991-2000)

Prevalência e prognóstico da peritonite bacteriana espontânea: experiência em pacientes internados em um hospital geral de Porto Alegre, RS, Brasil (1991-2000)

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

Infections Caused By Escherichia Coli Resistant to Norfloxacin in Hospitalized Cirrhotic Patients

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