Epidemiology of Severe Hospital‐Acquired Infections in Patients with Liver Cirrhosis: Effect of Long‐Term Administration of Norfloxacin

Abstract

We performed a 5-year retrospective study to evaluate the effect of long-term administration of norfloxacin on the epidemiology of severe hospital-acquired infections in patients with advanced cirrhosis. Sixty-seven episodes of spontaneous bacterial peritonitis and 60 episodes of bacteremia occurred in, respectively, 46 patients (group 1a) and 52 patients (group 1b) who did not receive norfloxacin, while 23 and 17 episodes occurred in 21 patients (group 2a) and 17 patients (group 2b) during or within 10 days after long-term administration of norfloxacin. Enterobacteriaceae were more prevalent in groups 1a and 1b than in the other two groups (P < .001 and P < .01, respectively); conversely, staphylococci were more prevalent in groups 2a and 2b (P < .001 and P < .05, respectively). The rate of staphylococcal resistance to methicillin was 53.6% in groups 1a and 1b and 77.3% in groups 2a and 2b. We conclude that long-term norfloxacin administration to cirrhotic patients reduces the risk of gram-negative infections but increases the risk of severe hospital-acquired staphylococcal infections and of high-level resistance to antibiotics.

Peritonite bacteriana espontânea: impacto das mudanças da microbiologia

“…Em pacientes que recebiam profi laxia para PBE, essa observação era mais notável e, particularmente interessante, bacteremias foram inteiramente devidas a bactérias gram-positivas (1) .…”

“…Em outro estudo, 53% da totalidade de infecções bacterianas em cirróticos hospitalizados foram devidas a cocos gram-positivos e, se a infecção fora caracterizada como nosocomial, esse índice subia para 59% (1) . Pacientes manejados em UTI e aqueles submetidos a procedimentos invasivos apresentaram taxas mais elevadas de infecções por cocos gram-positivos (77% vs. 48%, P <0,001 e 58% vs. 40%, P <0,02, respectivamente) (5) .…”

Prevalência e prognóstico da peritonite bacteriana espontânea: experiência em pacientes internados em um hospital geral de Porto Alegre, RS, Brasil (1991-2000)

“…Por outro lado, quanto à bacteriologia, embora sem haver diferença estatística, houve predomínio de bactérias Gram-positivas, o que vai ao encontro dos trabalhos que referem ser freqüente o surgimento destas no grupo que recebe antibiótico profilático (6,10,11,26,36) .…”

Trimethoprim-sulfamethoxazole versus norfloxacin in the prophylaxis of spontaneous bacterial peritonitis in cirrhosis

“…The greatest concern at present is the shifting range of causative agents of SBP and the development of bacterial resistance (6,11,12,13,31,32,33) .…”