Nosocomial Spontaneous Bacterial Peritonitis and Bacteremia in Cirrhotic Patients: Impact of Isolate Type on Prognosis and Characteristics of Infection

Abstract

The characteristics of and prognosis for nosocomial spontaneous bacterial peritonitis (SBP) and bacteremia were examined in a prospective study that included data from 194 consecutive episodes of SBP and 119 episodes of bacteremia, 93.3% of which were nosocomial, in 200 hospitalized cirrhotic patients. Gram-positive pathogens were predominant (70% of the total) among isolates from nosocomial infections; the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was 24.8%. Nosocomial and staphylococcal infections were associated with a higher mortality rate than were community-acquired infections (P=.0255) and nonstaphylococcal infections (P<.001), respectively. In comparison with non-MRSA infections, MRSA infections were more likely to recur and occurred in a greater number of sites other than ascitic fluid and blood (P=.0004). Older age (P=.0048), higher Child-Pugh score (P=.0011), and infection with staphylococci (P=.0031) were independently associated with a higher mortality rate. The emergence of MRSA is important because of the recurrence and poor outcome associated with infection with such organisms.

Peritonite bacteriana espontânea: impacto das mudanças da microbiologia

“…Talvez de maior relevância seja a observação do estudo francês de CAMPILLO et al (2) . Dentre 200 pacientes cirróticos hospitalizados com mais de 300 infecções documentadas, 93% foram caracterizadas como nosocomiais e cerca de 2/3 causadas por patógenos gram-positivos.…”

Bloodstream infections in patients with liver cirrhosis

“…As a consequence, the incidence of staphylococcal BSI has been increasing over the last 10 years. 9,37 Moreover, the extended use of antibiotic prophylaxis, mainly with norfloxacin, has exercised a selective pressure on both gut and hospital environment, resulting in an increasing rates of multi-drug-resistant (MDR) bacteria, extensively drug-resistant (XDR), and fungi. [38][39][40][41] Drawing a historical timeline ( Fig.…”

“…Then, the already mentioned changes in the supportive care of cirrhotic patients and the extended use of quinolone prophylaxis, drove a shift toward Gram-positive bacteria (GPB) infections, mainly staphylococci. 9,37 However, in the following years, GNB have been re-emerging as causes of BSI in cirrhotic patients as a consequence of multiple factors impacting in the whole hospital setting. They include i) improvement in the prevention of hospital-acquired infections, mainly those devices-related, has reduced the incidence of staphylococcal infections; ii) quinolones have lost activity against Gram-negative due to widespread and extended use; iii) the increased use of broader-spectrum antibiotics created ideal conditions for the selection and transmission of MDR/XDR GNB in hospitals worldwide.…”

Prognostic Importance of the Cause of Renal Failure in Patients With Cirrhosis

“…These data are in agreement with the increasingly recognized importance of gram-positive bacteria as a cause of infection in hospitalized patients with cirrhosis. 15,16 Fungal infections were also identified as a cause of renal failure, although their frequency was low.…”