Bacterial epidemiology and antimicrobial resistance in spontaneous infection of cirrhotic patients

Spontaneous ascites infection (SAI) is a and life threatening complication of decompensated liver cirrhosis. It has a high motality rate. This study was aimed to identify causative microorganisms and to compare them with the current literature to determine sensitivity to antibiotics and analyse sensitivity to empirical treatment protocols frequently used in clinics. Inclusion criteria to the the study were cirrhotic patients with ascites without secondary bacterial peritonitis, and without hepatocellular carcinoma. In this retrospective study conducted between 2007 January- 2015 September in Gastroenterology department, data were collected from 291 documented ascites fluid culture samples. Majority of the cases were secondary to chronic viral hepatitis and cryptogenic, most of whom were Child-Pugh C. Groups of patients with negative and positive ascites cultures were compared by age, gender, liver cirrhosis etiology, Child-Pugh score and hospital mortality. Patients were classified to SBP, culture negative neutrocyticascites (KNNA), monomicrobial nonneutrocytic bacterascites (MNBA) and simple ascites groups. Of the patients, 16 % had SBP, 7,9 % had MNBA, 12.7 % had KNNA, and 60.1 % had simple ascites. Growth in culture was observed in 72 patients (24.7 %). Gram positive cocci were isolated in 39cultures (48.1%) and gram negative bacteria were in 41 cultures (50.6%); multi drug resistance bacteria were isolated in 16 cultures (22.2%). The most frequent 3 bacteria were Escherichia coli 28 cultures (34.5%), Coagulase-negative staphylococci 20 cultures (24.6%) and Enterrococci 8 cultures (9.8%). Multi drug resistance bacteria were isolated 22.2 % and 43 % of those revealed hospital mortality. Most frequent bacteria were E.coli and sensitivity to anti bacterials used empirically in clinic were 69% for ceftriaxone, 70.8% for ceftazidime, 68% for cefotaxime, 68% for cefepim, 69.5% for cefuroxime, 71% for ciprofloxacin, 75% for levofloxacin. Coagulase-negative staphylococci showed 70 to 100 % sensitivity to most of antibiotic groups. Sensitivity to fluoroquinolones was about 65%. And some teoric antibiotic combinations (such as ceftriaxone/cefepime+ fluoroquinolone, piperasilin-tazobaktam+ fluoroquinolone, ampicillin-sulbactam + fluoroquinolone) significiantly increased the antimicrobial coverage. In this study positive bacterial growth rates in ascetic fluid were concurrent with present literature, except for KNS which was second in order. MDR bacteria and KNS were isolated in 22.2 % and 24.6 % of cases, respesctively, suggesting a change in bacterial profile antibiotic resistance in SBP and MNBA. Bacterial profiles and empirical antibiotics should be evaluated periodically in SBP.