Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2015; 21(36): 10409-10417
Published online Sep 28, 2015. doi: 10.3748/wjg.v21.i36.10409
Pathogen profile and drug resistance analysis of spontaneous peritonitis in cirrhotic patients
Yong-Tao Li, Cheng-Bo Yu, Jian-Rong Huang, Zheng-Ji Qin, Lan-Juan Li
Yong-Tao Li, Cheng-Bo Yu, Jian-Rong Huang, Lan-Juan Li, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Zheng-Ji Qin, Medical Statistics Office of Public Health Department, Nantong University, Nantong 226000, Jiangsu Province, China
Author contributions: Li LJ designed the research; Li YT performed the research; Yu CB and Huang JR contributed to providing patient data; Li YT and Qin ZJ analyzed the data; Li YT and Li LJ wrote the paper.
Supported by Grants from the National Basic Research Program of China, 973 Program, No. 2013CB531401.
Institutional review board statement: The study was reviewed and approved by the medical ethics committee at The First Affiliated Hospital of Zhejiang University School of Medicine.
Informed consent statement: Patients were not required to give informed consent to the study as the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. For full disclosure, the details of the study are published on the home page of the First Affiliated Hospital of Zhejiang University School of Medicine.
Conflict-of-interest statement: The authors declare no competing interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lan-Juan Li, MD, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. ljli@zju.edu.cn
Telephone: +86-571-87236458 Fax: +86-571-87236459
Received: March 26, 2015
Peer-review started: March 28, 2015
First decision: June 25, 2015
Revised: July 1, 2015
Accepted: September 2, 2015
Article in press: September 2, 2015
Published online: September 28, 2015
Abstract

AIM: To investigate the microbiological characteristics and drug resistance in liver cirrhosis patients with spontaneous peritonitis.

METHODS: We analyzed the data of patients with liver cirrhosis and abdominal infection at the First Affiliated Hospital of Zhejiang University between January 2011 and December 2013. Pathogens present in the ascites were identified, and their sensitivity to various antibiotics was determined.

RESULTS: We isolated 306 pathogenic bacteria from 288 cases: In 178 cases, the infection was caused by gram-negative strains (58.2%); in 85 cases, gram-positive strains (27.8%); in 9 cases, fungi (2.9%); and in 16 cases, more than one pathogen. The main pathogens were Escherichia coli (E. coli) (24.2%), Klebsiella pneumoniae (18.9%), Enterococcus spp. (11.1%), and Staphylococcus aureus (7.5%). Of the 306 isolated pathogens, 99 caused nosocomial infections and 207 caused community-acquired and other infections. The E. coli and K. pneumoniae strains produced more extended-spectrum β-lactamases in cases of nosocomial infections than non-nosocomial infections (62.5% vs 38%, P < 0.013; 36.8% vs 12.8%, P < 0.034, respectively). The sensitivity to individual antibiotics differed between nosocomial and non-nosocomial infections: Piperacillin/tazobactam was significantly more effective against non-nosocomial E. coli infections (4% vs 20.8%, P < 0.021). Nitrofurantoin had stronger antibacterial activity against Enterococcus species causing non-nosocomial infections (36.4% vs 86.3%, P < 0.009).

CONCLUSION: The majority of pathogens that cause abdominal infection in patients with liver cirrhosis are gram-negative, and drug resistance is significantly higher in nosocomial infections than in non-nosocomial infections.

Keywords: Liver cirrhosis, Spontaneous peritonitis, Drug sensitive test, Drug resistance

Core tip: Monitoring drug resistance in cases of abdominal infection with liver cirrhosis is important for establishing appropriate antibiotic regimes, reducing the generation of drug-resistant bacteria and reducing the associated mortality. Therefore, this study addressed two primary issues regarding spontaneous peritonitis in cirrhotic patients in China: first, the pathogen profile and, second, drug resistance, and determined the differences between nosocomial infections and non-nosocomial infections. Based on these findings, clinicians can select the appropriate antibiotic treatment to control the emergence and development of pathogenic bacteria-resistant strains in intra-abdominal infections.