title: Changes in nature and antibiotic resistance of bacteria causing peritonitis in cirrhotic patients over a 20 year period.
abstract: OBJECTIVE
  To assess all clinically and bacteriologically documented episodes of spontaneous bacterial peritonitis diagnosed in a single unit over a 20 year period, to identify changes in the nature and antibiotic resistance of the causative bacteria.
  
  
  METHODS
  A specialist liver disease unit in a tertiary care centre.
  
  
  METHODS
  Cultured ascitic fluid obtained in the course of 240 consecutive episodes of clinically and bacteriologically proven spontaneous bacterial peritonitis. Patient recruitment remained stable during the 20 year period in terms of the number of cirrhotic patients admitted and the severity of their condition.
  
  
  RESULTS
  78.7% of isolates were Enterobacteriaceae (Escherichia coli in 51%) and 19% were Gram positive cocci. Until 1979 all the Enterobacteriaceae had the wild phenotype, compared with only 50% at the end of the study period. Since 1993, 22% of Enterobacteriaceae have been resistant to third generation cephalosporins. Methicillin resistant staphylococci were only isolated after 1989.
  
  
  CONCLUSIONS
  Changes in the epidemiology and antibiotic resistance of bacteria causing spontaneous bacterial peritonitis must be monitored for optimal treatment.
authors.affiliation: Hôpital Albert Chenevier, Créteil, France.
authors.forename: C
authors.initials: C
authors.lastname: Dupeyron
authors.forename: B
authors.initials: B
authors.lastname: Campillo
authors.forename: N
authors.initials: N
authors.lastname: Mangeney
authors.forename: J P
authors.initials: JP
authors.lastname: Richardet
authors.forename: G
authors.initials: G
authors.lastname: Leluan
mesh_terms: D001202:Ascitic Fluid / Q000382:microbiology*; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D018988:Bacterial Translocation; D004352:Drug Resistance, Microbial; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification; D006095:Gram-Positive Cocci / Q000187:drug effects / Q000302:isolation & purification; D006757:Hospital Units; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D016106:Methicillin Resistance; D010538:Peritonitis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*