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KMID : 0882420080750010068
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Korean Journal of Medicine
2008 Volume.75 No. 1 p.68 ~ p.76
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Changing pattern of microorganisms and antibiotic resistance rate of spontaneous bacterial peritonitis: A 12-year experience
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Joo Moon-Kyung
Yeon Jong-Eun
Byun Kwan-Soo
Suh Sang-Jun
Lee Sun-Jae
Kim Ji-Hoon
Jung Young-Kul
Kim Jeong-Han
Yim Hyung-Joon
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Abstract
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Background/Aims : Recently, the prognosis for spontaneous bacterial peritonitis (SBP) has improved; however, the causative microorganisms and antibiotic resistance rates are changing. We evaluated the changing pattern of causative agents and antibiotic resistance rates of SBP over a 12-year period.
Methods : We retrospectively analyzed 113 patients who were diagnosed with SBP and in whom ascites cultures were positive between 1996 and 2007. The 12-year period was subdivided into 6-year terms (period A, 1996～2001; and period B, 2002～2007).
Results : One hundred thirteen of 410 cases of SPB had positive ascites cultures. Thirty-seven cases were from period A and 76 cases were from period B. Hospital-acquired SBP was more common during period B. Gram negative microorganisms were isolated from 78% of SBP cases, and the most common microorganism was E.coli (60%). The resistance rates for ampicillin and ciprofloxacin were similar between the two periods, but resistance to cefotaxime was more frequent in period B (3% vs. 26%, p=0.002), and ESBL-producing E.coli was only cultured in period B (0% vs. 32%, p=0.002). Most of the initial antibiotics used were cefotaxime; carbapenem was used as a secondary antibiotic only in period B (0% vs. 55%, p=0.007). ESBL-producing microorganisms were the only predictor of in-hospital mortality based multivariate analysis (OR: 4.14, 95% CI: 1.09-15.07, p=0.037).
Conclusions : No change in pattern of microorganisms in the ascites of patients with SBP was noted during the 12-year period under study, but there was a significant increase in the incidence of hospital-acquired SBP, resistance to cefotaxime, and ESBL-producing E.coli when comparing the outcomes of periods A and B. ESBL-producing microorganisms were the only predictor of in-hospital mortality. (Korean J Med 75:68-76, 2008)
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KEYWORD
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Liver cirrhosis, Peritonitis, Microorganism, Drug Resistance, Bacteria
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