1. Bacterial epidemiology and antimicrobial resistance in ascitic fluid: A 2-year retrospective study
- Author
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Christian Rabaud, Lionel Piroth, Yves Hansmann, Pascal Chavanet, Isabelle Patry, Tahar Hadou, Benoît Jaulhac, Anne Minello, Catherine Neuwirth, André Pechinot, Département d'infectiologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Department of Microbiology, Service d'Hépato-Gastro-Entérologie (CHU de Dijon), UFR des Sciences de Santé (Université de Bourgogne), and Université de Bourgogne ( UB )
- Subjects
Liver Cirrhosis ,Microbiology (medical) ,Cefotaxime ,MESH : Retrospective Studies ,medicine.medical_treatment ,Peritonitis ,MESH : Peritonitis ,Drug resistance ,MESH : Gram-Negative Bacterial Infections ,Microbial Sensitivity Tests ,[ SDV.MP.BAC ] Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology ,MESH : Drug Resistance, Bacterial ,Gram-Positive Bacteria ,Microbiology ,Antibiotic resistance ,Spontaneous bacterial peritonitis ,Drug Resistance, Bacterial ,Gram-Negative Bacteria ,medicine ,MESH : Liver Cirrhosis ,Ascitic Fluid ,Humans ,MESH : Anti-Bacterial Agents ,Gram-Positive Bacterial Infections ,Retrospective Studies ,Antiinfective agent ,General Immunology and Microbiology ,business.industry ,MESH : Humans ,General Medicine ,Amoxicillin ,MESH : Gram-Negative Bacteria ,medicine.disease ,MESH : Gram-Positive Bacterial Infections ,Anti-Bacterial Agents ,Infectious Diseases ,MESH : Ascitic Fluid ,Beta-lactamase ,MESH : Gram-Positive Bacteria ,MESH : Microbial Sensitivity Tests ,business ,Gram-Negative Bacterial Infections ,medicine.drug - Abstract
International audience; The bacterial epidemiology of bacterascites and spontaneous bacterial peritonitis is evolving. Four hundred and eleven strains isolated from ascites in cirrhotic patients from 5 French hospitals were isolated in 2006 and 2007. Of these, 114 were definitely associated with spontaneous bacterial peritonitis. The proportion of Gram-positive and Gram-negative agents was quite similar, even after excluding coagulase-negative staphylococci, or when considering only definite spontaneous bacterial peritonitis or community-acquired strains. Staphylococci and Escherichia coli were the most frequent pathogens, but enterococci were also involved in nearly 15% of the cases. Among the E. coli, 28% were intermediate or resistant to amoxicillin+clavulanate, 5.3% expressed cephalosporinases or extended beta-lactamases and 17.3% were intermediate or resistant to fluoroquinolones. Resistance to methicillin was observed in 27% of Staphylococcus aureus. Cefotaxime and amoxicillin-clavulanate remained the most effective 'single' agents, however on less than 70% of isolates. Some combinations (such as cefotaxime+amoxicillin) extended coverage to a further 15% of strains. Since inadequate empiric antibiotic therapy is associated with increased mortality, these combinations may be of great interest as first-line treatment, even though they may also lead to the development of antimicrobial resistance. Repeated epidemiological surveys and new clinical trials are thus needed.
- Published
- 2009