由抗生素耐药菌导致的特发性细菌性腹膜炎的临床意义

Kyoung-Ho Song*. Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital,Seongnam, Korea

Background: Spontaneous bacterial peritonitis (SBP) is a major cause of morbidity and mortality in cirrhosis patients. Gram negative bacilli, such as Escherichia coli and Klebsiella species (EK) are the most common cause of SBP. Recently, infections due to antibiotic-resistant microorganism have increased, especially by extended-spectrum β-lactamase-producing EK (ESBL-EK). However, among SBP in patients with advanced liver cirrhosis, the impacts of antibiotic-resistant (including ESBL-producing) organisms on clinical outcome and risk factors for infection have not been well focused.

Aims & Methods: Electronic searches in MEDLINE and EMBASE about SBP in patients with advanced liver cirrhosis were performed to elucidate clinical implications of SBP due to antibioticresistant microorganism.

Results: SBP due to microorganism which was resistant to third generation cephalosporin accounted for 5-15%. SBP due to antibiotic-resistant organism had poorer outcome than SBP by antibiotic-susceptible strain. Especially, 30-day mortality of SBP due to ESBL-EK was very high (about 50%). And the risk factors for the development of infection with antibiotic-resistant organisms that have been listed in several studies are: underlying severe hepatic dysfunction, nosocomial infection, longer hospital stay and ICU stay, presence of indwelling vascular catheter, prior administration of an antibiotic and higher severity of illness. Although the impact of a delay in effective initial treatment was controversial, several studies suggest that ineffective initial therapy may be a cause of the higher mortality.

Conclusions: SBP due to antibiotic-resistant organism had higher mortality than SBP by susceptible strain and ineffective initial therapy may be a cause of the higher rates of treatment failure and mortality. Therefore, it would seem reasonable to treat patients with SBP due to antibiotic-resistant organism with effective antibiotics straight away. However, the injudicious use of broad antimicrobial regimens is likely to result in further emergence of resistance. To promote the prudent use of antimicrobial agents, we need further efforts to identify the risk factors for antibiotic-resistant infection.