Korean J Hepatol.  2007 Sep;13(3):370-377. 10.3350/kjhep.2007.13.3.370.

Changes in the Profiles of Causative Agents and Antibiotic Resistance Rate for Spontaneous Bacterial Peritonitis: an Analysis of Cultured Microorganisms in Recent 12 Years

• Park MK
• Lee JH
• Byun YH
• Lee HI
• Gwak GY
• Choi MS
• Koh KC
• Paik SW
• Yoo BC
• Rhee JC

• KMID: 760738
• DOI: http://doi.org/10.3350/kjhep.2007.13.3.370

Abstract

BACKGROUNDS/AIMS: The causative agents for spontaneous bacterial peritonitis (SBP) and antibiotic resistance rate vary according to the regions and time. This study evaluated the recent changes in the profiles of microorganisms and antibiotic resistance rate for the choice of effective antibiotics in treating SBP. METHODS: The clinical records of 1,018 episodes of SBP from November, 1994 to December, 2005, were analyzed retrospectively. The profiles of the causative agents for SBP and the rate of antibiotic resistance were compared in every 4-year-term. RESULTS: The microorganisms were isolated in 394 out of 1018 episodes (38.7%). Gram negative and positive organisms constituted 71.6% and 21.3%, respectively. The five most commonly isolated organisms were E. coli (35.8%), K. pneumoniae (15.5%), viridans Streptococci (10.4%), S. pneumoniae (4.8%) and Aeromonas group (4.6%). The rate of E. coli resistant to cefotaxime (0%, 5.4%, 7.4%) and ciprofloxacin (4.3%, 21.6%, 28.4%) were increased in recent years. In the gram positive organisms, all isolates of viridans Streptococci and Pneumococci were sensitive to cefotaxime and ciprofloxacin. Recently, methicillin-resistant Staphylococcus aureus (MRSA) (28%) and vancomycin-resistant Enterococci (VRE) (31%) have been isolated. In each period, the overall antibiotic resistance rates to cefotaxime were 12.5%, 14.0%, 14.8%, to ciprofloxacin were 3.1%, 16.7%, 18.0%, and to imipenem were 4.7%, 7.0%, 4.2%. CONCLUSIONS: Cefotaxime may still be the choice of primary empirical antibiotics for the treatment of SBP in Korea because the rate of resistance is acceptable. However, it is important to be aware of the recent increase in ciprofloxacin-resistant E. coli, extended spectrum beta-lactamase (ESBL)-producing gram negative bacilli, MRSA and VRE.

Keyword

Liver cirrhosis; Ascites; Peritonitis; Antibiotic resistance

MeSH Terms

Adult
Aged
Anti-Bacterial Agents/therapeutic use
Bacterial Infections/drug therapy/*microbiology
Cefotaxime/therapeutic use
*Drug Resistance, Bacterial
Female
Gram-Negative Bacteria/drug effects/isolation & purification
Humans
Male
Methicillin Resistance
Middle Aged
Peritonitis/drug therapy/*microbiology
Retrospective Studies
Severity of Illness Index
Time Factors
Vancomycin Resistance