The Effects of Selective Gut Decontamination with Ciprofloxacin in Liver Cirrhosis Patients

Park, Chul Hee; Cheong, Hee Jin; Kim, Woo Joo; Kim, Min Ja; Lee, Chang Hong; Park, Seung Chul

Abstract

BACKGROUND
Spontaneous bacterial peritonitis (SBP) is a frequent complication of liver cirrhosis, with prevalence ranging from 5% to 25% during hospitalization. Enteric aerobic gram-negative bacteria are the most common causative organisms of SBP. Long term fluoroquinolone administration to cirrhotic patients reduces the risk of SBP but induces high level resistance to antibiotics. In this study, we compare the incidence, clinical characteristics of SBP and antibiotics-resistance of organisms isolated from ciprofloxacin-treated cirrhotic patients with those in cirrhotic patients not receiving fluoroquinone prophylaxis.
METHODS
Retrospective analysis was done. 55 ciprofloxacin-treated patients and 92 control patients were selected from cirrhotic patients, they were followed up in Korea university Guro hospital from August 1994 to July 1998. Clinical and laboratory data were compared in both group.
RESULTS
We found a significantly lower incidence of SBP in ciprofloxacin-treated patients [27% (15/55) vs 44% (41/92); P=0.03]. There were no significant difference in admission duration, treatment duration, cure rates and mortality. Gram-negative bacilli, especially E. coli are most frequent bacteria isolated from ascites on both groups (60.0% vs 53.6%). Ciprofloxacin resistant gram-negative bacilli were isolated more frequently in the treated group [50% (5/10) vs 16% (5/31); P=0.03]. Methicillin resistant gram-positive cocci were isolated more frequently in the treated group, also. The therapeutic response of SBP were good in spite of ciprofloxacin resistance (90%). High serum creatinine concentration was independent risk factor for poor prognosis of SBP.
CONCLUSION
Selective gut decontamination with long term ciprofloxacin in severe cirrhotic patients reduces incidence and recurrence of SBP, but has no significant influence on clinical features and prognosis of SBP. The prevalence of ciprofloxacin resistant gram-negative bacilli and methicillin resistant gram-positive bacilli increased in ciprofloxacin treated group. These findings should be taken into account when weighting the advantage and disadvantage of selective gut decontamination with ciprofloxacin.