Skip to main content
SpringerLink
Log in

Enterococcus: not an innocent bystander in cirrhotic patients with spontaneous bacterial peritonitis

  • Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Clinicians sometimes experience treatment failure in the initial empirical antibiotics treatment using cephalosporins in cirrhotic patients with spontaneous bacterial peritonitis (SBP). Enterococcus, which is intrinsically resistant to cephalosporins, may be one of the causes of treatment failure. The aim of this study was to evaluate the clinical importance and the clinical characteristics of spontaneous enterococcal peritonitis (SEP). This was a retrospective cohort study of 359 patients with SBP treated in a single tertiary care center in South Korea from January 2000 through December 2004. We evaluated the clinical manifestation and the treatment results of SBP patients with enterococci identified from ascites culture. During the observation period, 13 of 359 patients (3.6%) diagnosed with culture-positive SBP had enterococcal peritonitis. For the initial empirical treatment, third-generation cephalosporins were administered to the 13 patients, ten of whom (76.9%) did not improve in the first 48 h. An in vitro antibiotic sensitivity test showed that the identified enterococci were susceptible to ampicillin plus gentamycin in eight patients (61.5%) and there was no vancomycin-resistant enterococcus. Although antibiotics were changed to antienterococcal antibiotics in 11 patients, only five patients improved. As a result, eight of the 13 patients (61.5%) with enterococcal SBP died during the observation period, and the one-month mortality was significantly higher from enterococcal SBP than from nonenterococcal SBP (P = 0.038). We conclude that enterococcal SBP has poor prognosis and it is reasonable to use antienterococcal antibiotics when enterococcus is identified from ascites culture of patients with liver cirrhosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Guarner C, Soriano G (1997) Spontaneous bacterial peritonitis. Semin Liver Dis 17:203–217

    Article  PubMed  CAS  Google Scholar 

  2. Such J, Runyon BA (1998) Spontaneous bacterial peritonitis. Clin Infect Dis 27:669–676. doi:10.1086/514940

    Article  PubMed  CAS  Google Scholar 

  3. Felisart J, Rimola A, Arroyo V et al (1985) Cefotaxime is more effective than is ampicillin-tobramycin in cirrhotics with severe infections. Hepatology 5:457–462. doi:10.1002/hep.1840050319

    Article  PubMed  CAS  Google Scholar 

  4. Navasa M, Follo A, Llovet JM et al (1996) Randomized, comparative study of oral ofloxacin versus intravenous cefotaxime in spontaneous bacterial peritonitis. Gastroenterology 111:1011–1017. doi:10.1016/S0016-5085(96)70069-0

    Article  PubMed  CAS  Google Scholar 

  5. Moellering RC Jr, Eliopoulos GM (1984) Activity of cefotaxime against enterococci. Diagn Microbiol Infect Dis 2:85S–90S

    Article  PubMed  Google Scholar 

  6. Barie PS, Christou NV, Dellinger EP et al (1990) Pathogenicity of the enterococcus in surgical infections. Ann Surg 212:155–159. doi:10.1097/00000658-199008000-00007

    Article  PubMed  CAS  Google Scholar 

  7. Dougherty SH (1984) Role of enterococcus in intraabdominal sepsis. Am J Surg 148:308–312. doi:10.1016/0002-9610(84)90460-4

    Article  PubMed  CAS  Google Scholar 

  8. Gorbach SL (1993) Intraabdominal infections. Clin Infect Dis 17:961–965

    PubMed  CAS  Google Scholar 

  9. Nichols RL, Muzik AC (1992) Enterococcal infections in surgical patients: the mystery continues. Clin Infect Dis 15:72–76

    PubMed  CAS  Google Scholar 

  10. Rohrborn A, Wacha H, Schoffel U et al (2000) Coverage of enterococci in community acquired secondary peritonitis: results of a randomized trial. Surg Infect (Larchmt) 1:95–107. doi:10.1089/109629600321137

    Article  CAS  Google Scholar 

  11. Dupont H, Montravers P, Mohler J et al (1998) Disparate findings on the role of virulence factors of Enterococcus faecalis in mouse and rat models of peritonitis. Infect Immun 66:2570–2575

    PubMed  CAS  Google Scholar 

  12. Onderdonk AB, Bartlett JG, Louie T et al (1976) Microbial synergy in experimental intra-abdominal abscess. Infect Immun 13:22–26

    PubMed  CAS  Google Scholar 

  13. Montravers P, Mohler J, Saint Julien L et al (1997) Evidence of the proinflammatory role of Enterococcus faecalis in polymicrobial peritonitis in rats. Infect Immun 65:144–149

    PubMed  CAS  Google Scholar 

  14. Hassner A, Kletter Y, Shlag D et al (1981) Impaired monocyte function in liver cirrhosis. Br Med J (Clin Res Ed) 282:1262–1263

    CAS  Google Scholar 

  15. Kourilsky O, Leroy C, Peltier AP (1973) Complement and liver cell function in 53 patients with liver disease. Am J Med 55:783–790. doi:10.1016/0002-9343(73)90259-3

    Article  PubMed  CAS  Google Scholar 

  16. Rajkovic IA, Williams R (1986) Abnormalities of neutrophil phagocytosis, intracellular killing and metabolic activity in alcoholic cirrhosis and hepatitis. Hepatology 6:252–262. doi:10.1002/hep.1840060217

    Article  PubMed  CAS  Google Scholar 

  17. Soriano G, Guarner C, Tomás A et al (1992) Norfloxacin prevents bacterial infection in cirrhotics with gastrointestinal hemorrhage. Gastroenterology 103:1267–1272

    PubMed  CAS  Google Scholar 

  18. Blaise M, Pateron D, Trinchet JC et al (1994) Systemic antibiotic therapy prevents bacterial infection in cirrhotic patients with gastrointestinal hemorrhage. Hepatology 20:34–38

    Article  PubMed  CAS  Google Scholar 

  19. Rimola A, Bory F, Teres J et al (1985) Oral, nonabsorbable antibiotics prevent infection in cirrhotics with gastrointestinal hemorrhage. Hepatology 5:463–467. doi:10.1002/hep.1840050320

    Article  PubMed  CAS  Google Scholar 

  20. Barrall DT, Kenney PR, Slotman GJ et al (1985) Enterococcal bacteremia in surgical patients. Arch Surg 120:57–63

    PubMed  CAS  Google Scholar 

  21. Schlossberg D (2006) Clinical approach to antibiotic failure. Med Clin North Am 90:1265–1277. doi:10.1016/j.mcna.2006.07.004

    Article  PubMed  CAS  Google Scholar 

  22. Williamson R, le Bouguénec C, Gutmann L et al (1985) One or two low affinity penicillin-binding proteins may be responsible for the range of susceptibility of Enterococcus faecium to benzylpenicillin. J Gen Microbiol 131:1933–1940

    PubMed  CAS  Google Scholar 

  23. Moellering RC Jr (1983) Antibiotic synergism—lessons from the enterococcus. Trans Am Clin Climatol Assoc 94:55–62

    PubMed  Google Scholar 

  24. Hampel H, Bynum GD, Zamora E et al (2001) Risk factors for the development of renal dysfunction in hospitalized patients with cirrhosis. Am J Gastroenterol 96:2206–2210. doi:10.1111/j.1572-0241.2001.03958.x

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

This study was supported by the Seoul National University Hospital Research Fund (#03-2006-019) and the Korea Health 21 R&D Project (#0412-CR01-0704-0001).

Author information

Authors and Affiliations

  1. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 28 Yungun-dong, Chongno-gu, Seoul, 110–744, Republic of Korea

    J.-H. Lee, J.-H. Yoon, B. H. Kim, G. E. Chung, S. J. Myung, W. Kim, Y. J. Kim & H.-S. Lee

  2. Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

    E.-C. Kim

Authors
  1. J.-H. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J.-H. Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. H. Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. E. Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. J. Myung
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. W. Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Y. J. Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. E.-C. Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. H.-S. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J.-H. Yoon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, JH., Yoon, JH., Kim, B.H. et al. Enterococcus: not an innocent bystander in cirrhotic patients with spontaneous bacterial peritonitis. Eur J Clin Microbiol Infect Dis 28, 21–26 (2009). https://doi.org/10.1007/s10096-008-0578-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-008-0578-3

Keywords

Search

Navigation