Bacterial infections in cirrhosis:: Epidemiological changes with invasive procedures and norfloxacin prophylaxis
Bacterial infections in cirrhosis:: Epidemiological changes with invasive procedures and norfloxacin prophylaxis
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DOI：
10.1053/jhep.2002.30082
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发表时间：
2002-01-01
期刊：
影响因子：
13.5
通讯作者：
Rodés, J
中科院分区：
文献类型：
--
作者：
Fernández, J;Navasa, M;Rodés, J
在肝硬化患者的治疗中广泛使用侵入性操作和长期诺氟沙星预防治疗可能影响了肝硬化细菌感染的流行病学。我们对1998年4月至2000年4月间在一个肝脏单位诊断的肝硬化患者的所有细菌感染进行了前瞻性评价。在507例住院患者中，共有405例患者出现572例细菌感染。自发性细菌性腹膜炎是最常见的感染（138例）。革兰阳性球菌占研究中细菌感染总数的53%，是医院感染中分离的主要细菌（59%）。需要在重症监护室治疗的患者和接受侵入性操作的患者出现革兰氏阳性球菌感染的比例更高（分别为77% vs. 48%，P <0.001和58% vs. 40%，P <0.02）。长期使用诺氟沙星的患者（n = 93）和未接受该治疗的患者（n = 414）中，50%的培养阳性自发性细菌性腹膜炎由喹诺酮类耐药革兰阴性杆菌引起，P = 0.01。在长期使用诺氟沙星的患者中，由耐甲氧苄氨嘧啶-磺胺甲恶唑革兰阴性杆菌引起的培养阳性自发性细菌性腹膜炎的发生率也非常高（44% vs. 18%，P = 0.09）。总之，革兰氏阳性球菌引起的感染在肝硬化中明显增加。这一现象可能与目前高水平的内固定治疗有关。喹诺酮耐药自发性细菌性腹膜炎是长期使用诺氟沙星预防的患者的一个紧急问题，甲氧苄啶-磺胺甲恶唑不是有效的替代药物。
The extensive use of invasive procedures and of long-term norfloxacin prophylaxis in the management of cirrhotic patients may have influenced the epidemiology of bacterial infections in cirrhosis. We conducted a prospective evaluation of all bacterial infections diagnosed in patients with cirrhosis in a Liver Unit between April 1998 and April 2000. A total of 405 patients presented 572 bacterial infections in 507 admissions. Spontaneous bacterial peritonitis was the most frequent infection (138 cases). Gram-positive cocci were responsible for 53% of total bacterial infections in the study, being the main bacteria isolated in nosocomial infections (59%). Patients requiring treatment in an intensive care unit and those submitted to invasive procedures presented a higher rate of infections caused by grampositive cocci (77% vs. 48%, P < .001 and 58% vs. 40%, P < .02, respectively). Fifty percent of culture-positive spontaneous bacterial peritonitis in patients on long-term norfloxacin administration (n = 93) and 16% in patients not receiving this therapy (n = 414) were caused by quinolone-resistant gram-negative bacilli, P = .01. The rate of culture-positive spontaneous bacterial peritonitis caused by trimethoprim-sulfamethoxazole-resistant gramnegative bacilli was also very high in patients on long-term norfloxacin administration (44% vs. 18%, P = .09). In conclusion, infections caused by gram-positive cocci have markedly increased in cirrhosis. This phenomenon may be related to the current high degree of instrumentation of cirrhotic patients. Quinolone-resistant spontaneous bacterial peritonitis constitutes an emergent problem in patients on long-term norfloxacin prophylaxis, with trimethoprim-sulfamethoxazole not being a valid alternative.