Bacterial epidemiology and antimicrobial resistance in ascitic fluid: a 2-year retrospective study.
The bacterial epidemiology of bacterascites and spontaneous bacterial peritonitis is evolving. Four hundred and eleven strains isolated from ascites in cirrhotic patients from 5 French hospitals were isolated in 2006 and 2007. Of these, 114 were definitely associated with spontaneous bacterial peritonitis. The proportion of Gram-positive and Gram-negative agents was quite similar, even after excluding coagulase-negative staphylococci, or when considering only definite spontaneous bacterial peritonitis or community-acquired strains. Staphylococci and Escherichia coli were the most frequent pathogens, but enterococci were also involved in nearly 15% of the cases. Among the E. coli, 28% were intermediate or resistant to amoxicillin+clavulanate, 5.3% expressed cephalosporinases or extended beta-lactamases and 17.3% were intermediate or resistant to fluoroquinolones. Resistance to methicillin was observed in 27% of Staphylococcus aureus. Cefotaxime and amoxicillin-clavulanate remained the most effective 'single' agents, however on less than 70% of isolates. Some combinations (such as cefotaxime+amoxicillin) extended coverage to a further 15% of strains. Since inadequate empiric antibiotic therapy is associated with increased mortality, these combinations may be of great interest as first-line treatment, even though they may also lead to the development of antimicrobial resistance. Repeated epidemiological surveys and new clinical trials are thus needed.
Piroth
Lionel
L
Département d'Infectiologie, CHU, Dijon, France. lionel.piroth@chu-djon.fr
Pechinot
André
A
Minello
Anne
A
Jaulhac
Benoit
B
Patry
Isabelle
I
Hadou
Tahar
T
Hansmann
Yves
Y
Rabaud
Christian
C
Chavanet
Pascal
P
Neuwirth
Catherine
C
D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001202:Ascitic Fluid / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D006094:Gram-Positive Bacteria / Q000187:drug effects*; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008826:Microbial Sensitivity Tests; D010538:Peritonitis / Q000453:epidemiology / Q000382:microbiology*; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents