title: Clinical significance and outcome of nosocomial acquisition of spontaneous bacterial peritonitis in patients with liver cirrhosis.
abstract: BACKGROUND
  There have been few reports on the causes and treatment outcomes for nosocomial spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis.
  
  
  METHODS
  We performed a retrospective cohort study to compare the microbiological and clinical characteristics in nosocomial versus community-acquired SBP. All patients with SBP, for whom culture was proven to be positive for SBP at Samsung Medical Center (Seoul, Republic of Korea) from 1 January 2000 through 31 June 2007, were included. Medical records and laboratory data were reviewed. Nosocomial SBP was defined as SBP diagnosed after 72 h of hospitalization.
  
  
  RESULTS
  A total of 236 patients with SBP were enrolled (mean age +/- SD age, 56.6 +/- 10.7 years); 166 patients were women, and 70 were men. Nosocomial and community-acquired SBP occurred in 126 and 110 patients, respectively. Escherichia coli accounted for 102 (43.2%) of 236 isolates, Klebsiella species accounted for 33 isolates (14.0%), and Streptococcus species accounted for 23 isolates (9.8%). The overall 30-day mortality rate for nosocomial SBP was higher than that for community-acquired SBP (58.7% vs. 37.3%; P = .001). Nosocomial isolates of gram-negative organisms were significantly more resistant to third-generation cephalosporins (41% vs. 10.0%; P = .001) and quinolones (50.0% vs. 30.9%; P = .003), compared with community-acquired isolates. Multivariate analysis revealed that nosocomial infection, concomitant hepatocellular carcinoma, presentation with acute renal failure or shock, and resistance to third-generation cephalosporins were significant risk factors for 30-day mortality associated with SBP.
  
  
  CONCLUSIONS
  Nosocomial SBP has a poorer outcome than community-acquired SBP. The resistance to third-generation cephalosporins for gram-negative organisms, which are more common in nosocomial cases of SBP than in community-acquired cases of SBP, adversely affects the outcome of SBP in patients with liver cirrhosis.
authors.affiliation: Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Hae Suk
authors.initials: HS
authors.lastname: Cheong
authors.forename: Cheol-In
authors.initials: CI
authors.lastname: Kang
authors.forename: Jeong A
authors.initials: JA
authors.lastname: Lee
authors.forename: Soo Youn
authors.initials: SY
authors.lastname: Moon
authors.forename: Mi Kyong
authors.initials: MK
authors.lastname: Joung
authors.forename: Doo Ryeon
authors.initials: DR
authors.lastname: Chung
authors.forename: Kwang Cheol
authors.initials: KC
authors.lastname: Koh
authors.forename: Nam Yong
authors.initials: NY
authors.lastname: Lee
authors.forename: Jae-Hoon
authors.initials: JH
authors.lastname: Song
authors.forename: Kyong Ran
authors.initials: KR
authors.lastname: Peck
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007709:Klebsiella / Q000302:isolation & purification; D007723:Korea / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D012189:Retrospective Studies; D013291:Streptococcus / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents