Jayaraj K, Di Bisceglie A M, Gibson S
Department of Internal Medicine, Saint Louis University School of Medicine, Missouri 63104, USA.
Am J Gastroenterol. 1998 Sep;93(9):1556-8. doi: 10.1111/j.1572-0241.1998.00482.x.
Spontaneous bacterial peritonitis is a frequent and often serious complication of long-standing ascites in the presence of advanced liver disease. Coliform bacteria account for the infection in most cases and are thought to be related to translocation of bacteria from the bowel into the peritoneal cavity. The empiric use of cefotaxime is well established as most of the causative organisms are sensitive to this antibiotic. However, we report on a case of spontaneous bacterial peritonitis in a patient with hepatitis C related cirrhosis who was awaiting liver transplantation caused by infection with Listeria monocytogenes, in which the patient did not improve with empiric antibiotic therapy. This case adds to the 23 others reported in the literature since 1966. Our case raises some concerns about the universal empiric usage of cefotaxime for spontaneous bacterial peritonitis because it does not offer adequate coverage against organisms such as Listeria, enterococci, Pasturella, and anaerobes.
自发性细菌性腹膜炎是晚期肝病患者长期腹水常见且往往较为严重的并发症。大多数情况下，感染由大肠埃希菌引起，被认为与细菌从肠道移位至腹腔有关。由于大多数病原菌对头孢噻肟敏感，因此经验性使用头孢噻肟已得到广泛认可。然而，我们报告了一例丙型肝炎相关性肝硬化患者在等待肝移植期间发生自发性细菌性腹膜炎的病例，该病例由单核细胞增生李斯特菌感染引起，经验性抗生素治疗后患者病情未改善。自1966年以来，该病例是文献中报道的第24例此类病例。我们的病例引发了对头孢噻肟在自发性细菌性腹膜炎中普遍经验性使用的一些担忧，因为它对李斯特菌、肠球菌、巴斯德菌和厌氧菌等病原体的覆盖不足。
