title: Risk factor of community-onset spontaneous bacterial peritonitis caused by fluoroquinolone-resistant Escherichia coli in patients with cirrhosis.
abstract: OBJECTIVE
  Despite the high prevalence of antimicrobial-resistant Escherichia coli in hospital-acquired infections, the clinical epidemiology of fluoroquinolone (FQ) resistance in community-onset spontaneous bacterial peritonitis (SBP) in patients with cirrhosis is not well understood. This study was performed to evaluate clinical features and risk factors for community-onset SBP caused by FQ-resistant E. coli.
  
  
  METHODS
  A case-control control study was performed using cases of community-onset SBP from June 2000 to August 2011 at Samsung Medical Center (Seoul, Korea). Patients with FQ-resistant E. coli were designated as case patients. A control group I (CG I) patient was defined as a person whose clinical sample yielded FQ-susceptible E. coli, and a control group II (CG II) patient was defined as a person with a negative culture result.
  
  
  RESULTS
  A total of 82 subjects with community-onset SBP caused by E. coli were identified, of which 26 (31.7%) were FQ-resistant E. coli infection. Fifty-seven matched subjects were randomly selected for CG II. Compared with CG I, previous SBP episodes (OR, 4.91; 95% CI, 1.50-16.53; P = 0.010), prior use of FQ within 30 days (OR, 7.05; 95% CI, 1.17-42.38; P = 0.033), and third-generation cephalosporin resistance (OR, 17.68; 95% CI, 1.67-187.26; P = 0.017) were significantly associated with FQ-resistant E. coli. Compared with CG II, a previous SBP episode was significantly associated with FQ-resistant E. coli (OR, 4.20; 95% CI, 1.50-11.80; P = 0.006).
  
  
  CONCLUSIONS
  FQ-resistant E. coli is a significant cause of community-onset SBP, with relation to previous SBP episodes, recent FQ use and third-generation cephalosporin resistance.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jungok
authors.initials: J
authors.lastname: Kim
authors.forename: Cheol-In
authors.initials: CI
authors.lastname: Kang
authors.forename: Eun-Jeong
authors.initials: EJ
authors.lastname: Joo
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Ha
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Cho
authors.forename: Geum-Youn
authors.initials: GY
authors.lastname: Gwak
authors.forename: Doo Ryeon
authors.initials: DR
authors.lastname: Chung
authors.forename: Kyong Ran
authors.initials: KR
authors.lastname: Peck
authors.forename: Jae-Hoon
authors.initials: JH
authors.lastname: Song
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000302:isolation & purification / Q000502:physiology; D004927:Escherichia coli Infections / Q000209:etiology*; D005260:Female; D024841:Fluoroquinolones; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000382:microbiology*; D012307:Risk Factors
chemical_list: D024841:Fluoroquinolones
keywords: cirrhosis; fluoroquinolone-resistant E. coli; spontaneous bacterial peritonitis