title: Enterococcus: not an innocent bystander in cirrhotic patients with spontaneous bacterial peritonitis.
abstract: Clinicians sometimes experience treatment failure in the initial empirical antibiotics treatment using cephalosporins in cirrhotic patients with spontaneous bacterial peritonitis (SBP). Enterococcus, which is intrinsically resistant to cephalosporins, may be one of the causes of treatment failure. The aim of this study was to evaluate the clinical importance and the clinical characteristics of spontaneous enterococcal peritonitis (SEP). This was a retrospective cohort study of 359 patients with SBP treated in a single tertiary care center in South Korea from January 2000 through December 2004. We evaluated the clinical manifestation and the treatment results of SBP patients with enterococci identified from ascites culture. During the observation period, 13 of 359 patients (3.6%) diagnosed with culture-positive SBP had enterococcal peritonitis. For the initial empirical treatment, third-generation cephalosporins were administered to the 13 patients, ten of whom (76.9%) did not improve in the first 48 h. An in vitro antibiotic sensitivity test showed that the identified enterococci were susceptible to ampicillin plus gentamycin in eight patients (61.5%) and there was no vancomycin-resistant enterococcus. Although antibiotics were changed to antienterococcal antibiotics in 11 patients, only five patients improved. As a result, eight of the 13 patients (61.5%) with enterococcal SBP died during the observation period, and the one-month mortality was significantly higher from enterococcal SBP than from nonenterococcal SBP (P = 0.038). We conclude that enterococcal SBP has poor prognosis and it is reasonable to use antienterococcal antibiotics when enterococcus is identified from ascites culture of patients with liver cirrhosis.
authors.affiliation: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: J-H
authors.initials: JH
authors.lastname: Lee
authors.forename: J-H
authors.initials: JH
authors.lastname: Yoon
authors.forename: B H
authors.initials: BH
authors.lastname: Kim
authors.forename: G E
authors.initials: GE
authors.lastname: Chung
authors.forename: S J
authors.initials: SJ
authors.lastname: Myung
authors.forename: W
authors.initials: W
authors.lastname: Kim
authors.forename: Y J
authors.initials: YJ
authors.lastname: Kim
authors.forename: E-C
authors.initials: EC
authors.lastname: Kim
authors.forename: H-S
authors.initials: HS
authors.lastname: Lee
mesh_terms: D000368:Aged; D000667:Ampicillin / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001201:Ascites / Q000382:microbiology; D002511:Cephalosporins / Q000627:therapeutic use; D015331:Cohort Studies; D016983:Enterococcus / Q000302:isolation & purification*; D005260:Female; D005839:Gentamicins / Q000494:pharmacology; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D007723:Korea; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010538:Peritonitis / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014640:Vancomycin / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D005839:Gentamicins; D014640:Vancomycin; D000667:Ampicillin