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Role of immunosuppression in the development of quinolone‐resistant Escherichia coli spontaneous bacterial peritonitis and in the mortality of E. coli spontaneous bacterial peritonitis
Author(s) -
Cereto F.,
Molina I.,
González A.,
Del Valle O.,
Esteban R.,
Guardia J.,
Genescà J.
Publication year - 2003
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.2003.01491.x
Subject(s) - spontaneous bacterial peritonitis , quinolone , norfloxacin , peritonitis , medicine , microbiology and biotechnology , immunosuppression , escherichia coli , antibiotics , gastroenterology , ciprofloxacin , biology , ascites , biochemistry , gene
Summary Background : Norfloxacin decreases the incidence of spontaneous bacterial peritonitis in cirrhotics, but promotes the appearance of quinolone‐resistant Escherichia coli . Aim : To define the characteristics of quinolone‐resistant E. coli spontaneous bacterial peritonitis. Methods : E. coli ‐positive ascitic fluid cultures were identified during a 6‐year period. Data on quinolone‐sensitive and quinolone‐resistant E. coli spontaneous bacterial peritonitis were compared. Results : One hundred and two E. coli ‐positive ascitic fluid cultures were detected. Cirrhotics accounted for 67 cases. Spontaneous bacterial peritonitis was found in 47 of the 67 (70%) cases [35 (74%) caused by quinolone‐sensitive and 12 (26%) caused by quinolone‐resistant E. coli ]. Norfloxacin prophylaxis was higher in the quinolone‐resistant group (92% vs. 6%, P < 0.001). Compared with patients with quinolone‐sensitive E. coli spontaneous bacterial peritonitis, those with quinolone‐resistant E. coli spontaneous bacterial peritonitis showed a higher prevalence of associated immunosuppressive factors (immunosuppressive drugs, human immunodeficiency virus infection or cancer) (92% vs. 20%, P < 0.001). Steroid therapy was independently associated with quinolone‐resistant E. coli spontaneous bacterial peritonitis (odds ratio, 49; 95% confidence interval, 3.4–699; P = 0.004). The Child–Pugh score ( P = 0.03), immunosuppression ( P = 0.02) and renal failure ( P = 0.01) were independent predictors of E. coli spontaneous bacterial peritonitis‐related mortality. Conclusions : Associated immunosuppression is an important co‐factor for the development of quinolone‐resistant E. coli spontaneous bacterial peritonitis and for E. coli spontaneous bacterial peritonitis‐related mortality.