Nosocomial spontaneous bacterial peritonitis and bacteremia in cirrhotic patients: impact of isolate type on prognosis and characteristics of infection.
The characteristics of and prognosis for nosocomial spontaneous bacterial peritonitis (SBP) and bacteremia were examined in a prospective study that included data from 194 consecutive episodes of SBP and 119 episodes of bacteremia, 93.3% of which were nosocomial, in 200 hospitalized cirrhotic patients. Gram-positive pathogens were predominant (70% of the total) among isolates from nosocomial infections; the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was 24.8%. Nosocomial and staphylococcal infections were associated with a higher mortality rate than were community-acquired infections (P=.0255) and nonstaphylococcal infections (P<.001), respectively. In comparison with non-MRSA infections, MRSA infections were more likely to recur and occurred in a greater number of sites other than ascitic fluid and blood (P=.0004). Older age (P=.0048), higher Child-Pugh score (P=.0011), and infection with staphylococci (P=.0031) were independently associated with a higher mortality rate. The emergence of MRSA is important because of the recurrence and poor outcome associated with infection with such organisms.
Campillo
Bernard
B
Service de Réeducation Digestive, Hôpital Albert Chenevier, 94010 Creteil Cedex, France. bernard.campillo@ach.ap-hop-paris.fr
Richardet
Jean-Philippe
JP
Kheo
Tuan
T
Dupeyron
Catherine
C
D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000401:mortality; D018890:Chemoprevention; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D005260:Female; D006801:Humans; D007962:Leukocytes; D008103:Liver Cirrhosis / Q000150:complications* / Q000382:microbiology; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D010538:Peritonitis / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D013211:Staphylococcus aureus; D013291:Streptococcus