title: Spontaneous bacterial peritonitis in patients with cirrhosis undergoing selective intestinal decontamination. A retrospective study of 229 spontaneous bacterial peritonitis episodes.
abstract: OBJECTIVE
  Selective intestinal decontamination with norfloxacin is widely used to prevent spontaneous bacterial infections in cirrhosis. The study was performed to compare the spontaneous bacterial peritonitis occurring in patients with and without prophylactic norfloxacin.
  
  
  METHODS
  Two hundred and twenty-nine consecutive episodes of spontaneous bacterial peritonitis, (193 in patients without (Group A) and 36 in patients with norfloxacin prophylaxis (Group B)), were retrospectively analyzed. In 100 episodes (86 and 14, respectively), the responsible organism was isolated in ascitic fluid.
  
  
  RESULTS
  Clinical and laboratory data at diagnosis were comparable in both groups. There were marked differences (p < 0.001) between group A and B in the frequency of peritonitis caused by gram-negative (67.4% vs. 14.3%) and gram-positive (30.2% vs. 78.6%) bacteria. There were three polymicrobial episodes. Bacteria resistant to cefotaxime and gram-negative bacilli resistant to quinolones were isolated in ascitic fluid in nine (seven in Group A and two in Group B) and three episodes (all in Group A), respectively. No differences in the course of infection and patient survival were observed between groups.
  
  
  CONCLUSIONS
  Spontaneous bacterial peritonitis in patients with and without prophylaxis with norfloxacin are not different in clinical features, response to treatment and prognosis. Spontaneous bacterial peritonitis caused by gram-negative organisms resistant to quinolones is extremely uncommon in patients with cirrhosis receiving prophylactic norfloxacin.
authors.affiliation: Department of Gastroenterology, Hospital Germans Trias i Pujol, Badalona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Llovet
authors.forename: P
authors.initials: P
authors.lastname: Rodríguez-Iglesias
authors.forename: E
authors.initials: E
authors.lastname: Moitinho
authors.forename: R
authors.initials: R
authors.lastname: Planas
authors.forename: R
authors.initials: R
authors.lastname: Bataller
authors.forename: M
authors.initials: M
authors.lastname: Navasa
authors.forename: M
authors.initials: M
authors.lastname: Menacho
authors.forename: A
authors.initials: A
authors.lastname: Pardo
authors.forename: A
authors.initials: A
authors.lastname: Castells
authors.forename: E
authors.initials: E
authors.lastname: Cabré
authors.forename: V
authors.initials: V
authors.lastname: Arroyo
authors.forename: M A
authors.initials: MA
authors.lastname: Gassull
authors.forename: J
authors.initials: J
authors.lastname: Rodés
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D018988:Bacterial Translocation; D005260:Female; D006801:Humans; D015994:Incidence; D007422:Intestines / Q000382:microbiology*; D008103:Liver Cirrhosis / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009643:Norfloxacin / Q000627:therapeutic use*; D010538:Peritonitis / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control; D011379:Prognosis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
chemical_list: D000890:Anti-Infective Agents; D009643:Norfloxacin