Bert F, Panhard X, Johnson J, Lecuyer H, Moreau R, Le Grand J, Johnston B, Sinègre M, Valla D, Nicolas-Chanoine M-H
Service de Microbiologie, Hôpital AP-HP Beaujon, Clichy, France.
Clin Microbiol Infect. 2008 Nov;14(11):1034-40. doi: 10.1111/j.1469-0691.2008.02088.x.
Spontaneous bacterial peritonitis (SBP) is a severe complication in patients with cirrhosis and ascites. It is predominantly caused by Escherichia coli. The phylogenetic group and virulence genotype of E. coli isolates causing SBP were investigated, and the association of these characteristics with host factors and prognosis was examined. Seventy-six episodes of E. coli SBP that occurred over a 9-year period were studied. The phylogenetic group of the isolates and the presence of 36 virulence factor genes were investigated. The influence of bacterial and host factors on in-hospital mortality was assessed by multiple logistic regression. Phylogenetic groups A, B1, B2 and D were found in 26%, 4%, 46% and 24% of the isolates, respectively. Virulence factor genes were more frequent in B2 isolates than in non-B2 isolates (mean virulence score 15.4 vs. 7.3, p <10(-4)). Ciprofloxacin resistance was significantly associated with non-B2 groups and a low virulence score. Host factors independently associated with a shift from B2 to non-B2 isolates were norfloxacin prophylaxis (OR 13.01, p 0.0213) and prothrombin ratio (OR 1.04 for a 10% decrease, p 0.0211). The model for end-stage liver disease (MELD) score (OR 1.83, p 0.0007) and hospital-acquired SBP (OR 4.13, p 0.0247) were independent predictors of in-hospital mortality. In contrast, outcome was not influenced by the phylogenetic group or the virulence profile. These findings indicate that the characteristics of E. coli isolates causing SBP vary with the severity of liver disease and with fluoroquinolone prophylaxis. Host factors are more important than bacterial factors in predicting in-hospital mortality.
自发性细菌性腹膜炎（SBP）是肝硬化腹水患者的一种严重并发症。主要由大肠杆菌引起。对导致SBP的大肠杆菌分离株的系统发育群和毒力基因型进行了研究，并检查了这些特征与宿主因素和预后的关联。研究了9年内发生的76例大肠杆菌SBP病例。调查了分离株的系统发育群以及36个毒力因子基因的存在情况。通过多元逻辑回归评估细菌和宿主因素对住院死亡率的影响。分别在26%、4%、46%和24%的分离株中发现了系统发育群A、B1、B2和D。B2分离株中的毒力因子基因比非B2分离株更常见（平均毒力评分15.4对7.3，p<10⁻⁴）。环丙沙星耐药性与非B2群和低毒力评分显著相关。与从B2分离株转变为非B2分离株独立相关的宿主因素是诺氟沙星预防（OR 13.01，p 0.0213）和凝血酶原比率（每降低10%，OR 1.04，p 0.0211）。终末期肝病模型（MELD）评分（OR 1.83，p 0.0007）和医院获得性SBP（OR 4.13，p 0.0247）是住院死亡率的独立预测因素。相比之下，结局不受系统发育群或毒力谱的影响。这些发现表明，导致SBP的大肠杆菌分离株的特征随肝病严重程度和氟喹诺酮预防情况而变化。在预测住院死亡率方面，宿主因素比细菌因素更重要。
