title: Spontaneous bacterial peritonitis caused by Aeromonas caviae in a patient with cirrhosis.
abstract: Spontaneous bacterial peritonitis (SBP) is a common complication of cirrhosis. Based on our current understanding of SBP, the most common etiologies for SBP in cirrhosis are Enterobacter and Streptococcal species. Th e Aeromonas species are ubiquitous in fresh or sea water. Aeromonas caviae is never identified as etiology in cases of SBP. A patient, who had a history of liver cirrhosis related to chronic hepatitis B virus infection for 1 year, presented with diarrhea. He had diarrhea 1 week later returned from coastal city. He was hospitalized and treated with norfloxacin after 7 days of severe symptoms, including fever, abdominal distention, and diarrhea. Analysis of the ascitic specimen revealed a white-cell count of 4.42 × 109 cells/L with 88% neutrophils. Analysis of stool specimen showed a white-cell count of 60 cells per high-power field. Th e patient started the injection of cefriaxone at a dose of 4 g/d. However, the situation was not improved. Th ree days later, stool and ascitic fluid culture showed positive for Aeromonas caviae. Antibiotic susceptibility testing revealed that imipenem, meropenem, amikacin, and cefoperazone-sulbactam were highly sensitive to the Aeromonas caviae. However, the bacilli resisted to ceftriaxone, ceftazidime, ampicillin-sulbactam, levofloxacin, and sulfamethoxazole. Ceftriaxone was then switched to imipenem. The patient was fully recovered 14 days later. Aeromonas caviae is a rare pathogen of SBP in cirrhosis. It resists to third-generation of cephalosporin and fluroquinolone, which are of frequently used dependent on clinical experience. It needs a special attention.
authors.affiliation: Department of Infectious Disease, Affi liated Hospital of Qingdao University, Qingdao Shandong 266003, China.
authors.forename: Deyu
authors.initials: D
authors.lastname: Huang
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhao
authors.forename: Yueping
authors.initials: Y
authors.lastname: Jiang
authors.forename: Zhongbin
authors.initials: Z
authors.lastname: Li
authors.forename: Wucai
authors.initials: W
authors.lastname: Yang
authors.forename: Guofeng
authors.initials: G
authors.lastname: Chen
mesh_terms: D057585:Aeromonas caviae; D000890:Anti-Infective Agents; D001202:Ascitic Fluid; D016905:Gram-Negative Bacterial Infections / Q000473:pathology*; D006801:Humans; D007958:Leukocyte Count; D008103:Liver Cirrhosis; D008297:Male; D008826:Microbial Sensitivity Tests; D010538:Peritonitis / Q000382:microbiology* / Q000473:pathology
chemical_list: D000890:Anti-Infective Agents