Increasing frequency of Gram‐positive bacteria in spontaneous bacterial peritonitis

Cholongitas, Εvangelos; Papatheodoridis, George V.; Lahanas, Alexandros; Xanthaki, Anna; Kontou-Kastellanou, Chrysoula; Archimandritis, Athanasios

doi:10.1111/j.1478-3231.2004.0985.x

Cited by 68 publications

(83 citation statements)

References 14 publications

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“…They found a higher proportion of quinolone-resistant gram-negative bacilli infections among patients receiving norfloxacin prophylaxis but found no difference by duration of norfloxacin therapy. Cholongitas et al 32 reported that gram-positive bacteria caused SBP in their patients significantly more frequently during 2000-2002 than during 1998-1999 (P ϭ 0.04). Interestingly, none of their patients had been receiving prophylactic antibiotic therapy.…”

Section: Discussionmentioning

confidence: 99%

Streptococcus salivarius bacteremia and spontaneous bacterial peritonitis in liver transplantation candidates

et al. 2007

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Bacterial infections are a serious complication of end-stage liver disease (ESLD) that occurs in 20% to 60% of patients. We retrospectively reviewed medical records of patients with ESLD who were identified by our microbiology laboratory as having Streptococcus salivarius bacteremia. Of 592 patients listed for transplantation between January 1998 and January 2006, 9 (1.5%) had 10 episodes of S salivarius bacteremia. Of 2 patients already receiving quinolone prophylaxis for spontaneous bacterial peritonitis (SBP), 1 later presented with a second episode. The male-to-female ratio was 1:1.2. Medians for age, Model for End-Stage Liver Disease score, and Child-Turcotte-Pugh score were 50 years, 17, and 10, respectively. Presenting symptoms and signs in 10 episodes of infection were ascites (in 8 episodes), elevated temperature (6), abdominal pain (5) Bacterial infections are a common and serious complication of end-stage liver disease (ESLD). Their prevalence has been reported to range from 20 to 60%. 1,2 They are associated with increased morbidity and overall in-hospital mortality.1,2 Proposed mechanisms for increased risk of infection are changes in humoral immunity with a decreased synthesis in the complement system, 3 a decrease in the phagocytosis capability of the hepatic reticuloendothelial system, 4 an alteration in the function of neutrophils, 5,6 and a reduction in opsonic activity of ascitic fluid. 7 In addition, rupture of natural barriers induced by invasive diagnostic or therapeutic procedures may be involved in the pathogenesis of infections.Commonly observed infections in cirrhotic patients are pneumonia, urinary tract infection, spontaneous bacterial peritonitis (SBP), and bacteremia. Most of these infections are community acquired. In 1 series, two-thirds of the episodes were caused by gram-negative bacteria, 21% by gram-positive bacteria, and 3% by anaerobic bacteria. 8 In a more recent series of 117 cases of bacteremia, about one-half of the infections were caused by gram-negative bacteria and about onehalf by gram-positive bacteria. 9 We have encountered cases of S salivarius bacteremia among patients listed for liver transplantation at our tertiary care academic medical institution. Herein, we present our experience with this infection in patients with ESLD who were managed at our institution. PATIENTS AND METHODSAfter we encountered 2 liver transplantation candidates with S salivarius bacteremia, we reviewed the electronic Abbreviations: ESLD, end-stage liver disease; SBP, spontaneous bacterial peritonitis; VGS, viridans group streptococci.

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Section: Discussionmentioning

confidence: 99%

Streptococcus salivarius bacteremia and spontaneous bacterial peritonitis in liver transplantation candidates

et al. 2007

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“…The applicability in the clinical practice of a guideline derived from randomized controlled investigations is very important. Moreover, such analysis is also justified by the evidence that the type and etiology of bacterial infections in cirrhosis may have changed during recent years [14][15][16][17][18] . For this purpose, the results of patients' management according to these guidelines were evaluated in an unselected group of cirrhotic patients with SBP consecutively observed in the last three-year period.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, there have been suggestions that the type and etiology of bacterial infections in cirrhosis may have changed during recent years [14,15] . An increasing incidence of SBP caused by Gram-positive bacteria in cirrhotic patients with ascites has been observed by different authors [16,17] . In addition, an increased frequency of bacteria resistant to multiple antibiotics has been shown [18] .…”

Section: Introductionmentioning

confidence: 99%

Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice

Angeloni

Leboffe²,

Parente³

et al. 2008

WJG

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Aim: To verify the validity of the International Ascites Club guidelines for treatment of spontaneous bacterial peritonitis (SBP) in clinical practice. Methods: All SBP episodes occurring in a group of consecutive cirrhotics were managed accordingly and included in the study. SBP was diagnosed when the ascitic fluid polymorphonuclear (PMN) cell count was > 250 cell/mm3, and empirically treated with cefotaxime. Results: Thirty-eight SBP episodes occurred in 32 cirrhotics (22 men/10 women; mean age: 58.6 ± 11.2 years). Prevalence of SBP, in our population, was 17%. Ascitic fluid culture was positive in nine (24%) cases only. Eleven episodes were nosocomial and 71% community-acquired. Treatment with cefotaxime was successful in 59% of cases, while 41% of episodes required a modification of the initial antibiotic therapy because of a less-than 25% decrease in ascitic PMN count at 48 h. Change of antibiotic therapy led to the resolution of infection in 87% of episodes. Among the cases with positive culture, the initial antibiotic therapy with cefotaxime failed at a percentage (44%) similar to that of the whole series. In these cases, the isolated organisms were either resistant or with an inherent insufficient susceptibility to cefotaxime. Conclusion: In clinical practice, ascitic PMN count is a valid tool for starting a prompt antibiotic treatment and evaluating its efficacy. The initial treatment with cefotaxime failed more frequently than expected. An increase in healthcare-related infections with antibiotic-resistant pathogens may explain this finding. A different first-line antibiotic treatment should be investigated. © 2008 WJG. All rights reserved

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“…Our findings clearly demonstrated that intestinal decontamination with rifaximin resulted in a significant reduction in the mean serum levels of the pro-inflammatory cytokines (TNF-α and IL-6) and a significant increase in the serum level of the anti-inflammatory cytokine (IL-10). Recurrence of SBP episodes in patients on norfloxacin therapy was due to gram-positive organisms that are not sensitive to this therapy (26). Both rifaximin and norfloxacin showed a statistically significant decrease in serum TNF-α and IL-6 levels in comparison with their baseline data.…”

Section: Mostafa Et Al the Efficacy Of Rifaximin The In Prophylaxis mentioning

confidence: 81%

“…Furthermore, rifaximin has better activity against gram-positive organisms over norfloxacin (10). This is very important, particularly with increasing frequency of gram-positive bacteria in spontaneous bacterial peritonitis (26).…”

Section: Mostafa Et Al the Efficacy Of Rifaximin The In Prophylaxis mentioning

confidence: 99%

The efficacy and the immunomodulatory effect of rifaximin in prophylaxis of spontaneous bacterial peritonitis in cirrhotic Egyptian patients

Mostafa

Badra²,

Abdallah³

2015

Turk J Gastroenterol

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Background/Aims: This study aimed to evaluate the efficacy and the immunomodulatory effect of rifaximin as another promising prophylactic therapy against spontaneous bacterial peritonitis (SBP) in cirrhotics. Materials and Methods: Seventy cirrhotic patients with ascites were included in the study. Patients were divided into two groups in a randomized single-blind fashion. Group one (n=40) received rifaximin and group two (n=30) received norfloxacin (control group). The treatment duration was 6 months. Serum levels of tumor necrosis factor alpha (TNF-α), interleukin-6 ( IL-6), and interleukin-10 (IL-10) were the primary inflammatory markers of the study to evaluate the effect of the medications used. Results: Three months after treatment, five cases on norfloxacin therapy showed SBP, whereas all cases on rifaxmine therapy were free from SBP. In addition, there was no significant difference between patients on rifaximin and norfloxacin therapy with respect to TNF-α, IL-6, and IL-10 serum levels (p>0.05). Furthermore, patients on both rifaximin and norfloxacin therapies showed a statistically significant decrease in TNF-α and IL-6 serum levels compared with their baseline levels (p=0.000 and p=0.000, respectively). In contrast, serum IL-10 showed a statistically significant increase in both groups in comparison with its baseline level (p>0.00). Six-month after treatment, patients on rifaximin therapy showed more effective remission from SBP than those on norfloxacin therapy. Conclusion: In conclusion, the use of rifaximin not only prevents bacterial translocation but also modulates the immune response of the inflammatory and the anti-inflammatory cytokines in SBP patients. However, the efficacy and the immunomodulatory effect of rifaximin in the prophylaxis of SBP in cirrhotics needs further prospective large-scale, double-blind studies.

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Increasing frequency of Gram‐positive bacteria in spontaneous bacterial peritonitis

Abstract: Culture-positive SBP in cirrhotic patients are caused more frequently by Gram-positive bacteria during the recent years, which are, in their vast majority, resistant to quinolones.

Cited by 68 publications

References 14 publications

Streptococcus salivarius bacteremia and spontaneous bacterial peritonitis in liver transplantation candidates

Streptococcus salivarius bacteremia and spontaneous bacterial peritonitis in liver transplantation candidates

Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice

The efficacy and the immunomodulatory effect of rifaximin in prophylaxis of spontaneous bacterial peritonitis in cirrhotic Egyptian patients

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