Almeida Paulo Roberto Lerias de, Leão Gabriel Stefani, Gonçalves Charlles David Gonçalves, Picon Rafael Veiga, Tovo Cristiane Valle
Hospital Nossa Senhora da Conceição (HNSC), Porto Alegre, RS, Brasil.
Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brasil.
Arq Gastroenterol. 2018 Jan-Mar;55(1):23-27. doi: 10.1590/S0004-2803.201800000-08.
Spontaneous bacterial peritonitis is a serious complication in cirrhotic patients, and changes in the microbiological characteristics reported in the last years are impacting the choice of antibiotic used for treatment.
The aim of the present study is to evaluate the changes in the epidemiology and bacterial resistance of the germs causing spontaneous bacterial peritonitis over three different periods over 17 years.
All cirrhotic patients with spontaneous bacterial peritonitis and positive culture of ascites fluid were retrospectively studied in a reference Hospital in Southern Brazil. Three periods were ramdomly evaluated: 1997-1998, 2002-2003 and 2014-2015. The most frequent infecting organisms and the sensitivity in vitro to antibiotics were registered.
In the first period (1997-1998) there were 33 cases, the most common were: E. coli in 13 (36.11%), Staphylococcus coagulase-negative in 6 (16.66%), K. pneumoniae in 5 (13.88%), S. aureus in 4 (11.11%) and S. faecalis in 3 (8.33%). In the second period (2002-2003), there were 43 cases, the most frequent were: Staphylococus coagulase-negative in 16 (35.55%), S. aureus in 8 (17.77%), E. coli in 7 (15.55%) and K. pneumoniae in 3 (6.66%). In the third period (2014-2015) there were 58 cases (seven with two bacteria), the most frequent were: E. coli in 15 (23.1%), S. viridans in 12 (18.5%), K. pneumoniae in 10 (15.4%) and E. faecium 5 (7.7%). No one was using antibiotic prophylaxis. Considering all staphylococci, the prevalence increased to rates of the order of 50% in the second period, with a reduction in the third period evaluated. Likewise, the prevalence of resistant E. coli increased, reaching 14%.
There was a modification of the bacterial population causing spontaneous bacterial peritonitis, with high frequency of gram-positive organisms, as well as an increase in the resistance to the traditionally recommended antibiotics. This study suggests a probable imminent inclusion of a drug against gram-positive organisms in the empiric treatment of spontaneous bacterial peritonitis.
自发性细菌性腹膜炎是肝硬化患者的一种严重并发症，近年来报告的微生物学特征变化正在影响用于治疗的抗生素选择。
本研究的目的是评估17年间三个不同时期引起自发性细菌性腹膜炎的细菌的流行病学和耐药性变化。
在巴西南部一家参考医院对所有患有自发性细菌性腹膜炎且腹水培养阳性的肝硬化患者进行回顾性研究。随机评估三个时期：1997 - 1998年、2002 - 2003年和2014 - 2015年。记录最常见的感染病原体以及体外抗生素敏感性。
在第一个时期（1997 - 1998年）有33例病例，最常见的是：大肠杆菌13例（36.11%）、凝固酶阴性葡萄球菌6例（16.66%）、肺炎克雷伯菌5例（13.88%）、金黄色葡萄球菌4例（11.11%）和粪肠球菌3例（8.33%）。在第二个时期（2002 - 2003年），有43例病例，最常见的是：凝固酶阴性葡萄球菌16例（35.55%）、金黄色葡萄球菌8例（17.77%）、大肠杆菌7例（15.55%）和肺炎克雷伯菌3例（6.66%）。在第三个时期（2014 - 2015年）有58例病例（7例为两种细菌感染），最常见的是：大肠杆菌15例（23.1%）、草绿色链球菌12例（18.5%）、肺炎克雷伯菌10例（15.4%）和屎肠球菌5例（7.7%）。无人使用抗生素预防。考虑所有葡萄球菌，其患病率在第二个时期增至约50%，在第三个评估时期有所下降。同样，耐药大肠杆菌的患病率增加，达到14%。
引起自发性细菌性腹膜炎的细菌菌群发生了改变，革兰氏阳性菌感染频率较高，并且对传统推荐抗生素的耐药性增加。本研究表明在自发性细菌性腹膜炎的经验性治疗中可能即将纳入针对革兰氏阳性菌的药物。
