최근 12년간 발생한 자발성 세균성 복막염의 균주와 항생제 내성의 변화 (Changing pattern of microorganisms and antibiotic resistance rate of spontaneous bacterial peritonitis: A 12-year experience)

서지정보

· 발행기관 : 대한내과학회
· 수록지 정보 : 대한내과학회지 / 75권 / 1호 / 68 ~ 76페이지
· 저자명 : 주문경, 연종은, 이순재, 서상준, 정영걸, 김정한, 김지훈, 임형준, 변관수

초록

Background/Aims : Recently, the prognosis for spontaneous bacterial peritonitis (SBP) has improved; however, the causative microorganisms and antibiotic resistance rates are changing. We evaluated the changing pattern of causative agents and antibiotic resistance rates of SBP over a 12-year period.
Methods : We retrospectively analyzed 113 patients who were diagnosed with SBP and in whom ascites cultures were positive between 1996 and 2007. The 12-year period was subdivided into 6-year terms (period A, 1996～2001; and period B, 2002～2007).
Results : One hundred thirteen of 410 cases of SPB had positive ascites cultures. Thirty-seven cases were from period A and 76 cases were from period B. Hospital-acquired SBP was more common during period B. Gram negative microorganisms were isolated from 78% of SBP cases, and the most common microorganism was E.coli (60%). The resistance rates for ampicillin and ciprofloxacin were similar between the two periods, but resistance to cefotaxime was more frequent in period B (3% vs. 26%, p=0.002), and ESBL-producing E.coli was only cultured in period B (0% vs. 32%, p=0.002). Most of the initial antibiotics used were cefotaxime; carbapenem was used as a secondary antibiotic only in period B (0% vs. 55%, p=0.007). ESBL-producing microorganisms were the only predictor of in-hospital mortality based multivariate analysis (OR: 4.14, 95% CI: 1.09-15.07, p=0.037).
Conclusions : No change in pattern of microorganisms in the ascites of patients with SBP was noted during the 12-year period under study, but there was a significant increase in the incidence of hospital-acquired SBP, resistance to cefotaxime, and ESBL-producing E.coli when comparing the outcomes of periods A and B. ESBL-producing microorganisms were the only predictor of in-hospital mortality. (Korean J Med 75:68-76, 2008)

영어초록

Background/Aims : Recently, the prognosis for spontaneous bacterial peritonitis (SBP) has improved; however, the causative microorganisms and antibiotic resistance rates are changing. We evaluated the changing pattern of causative agents and antibiotic resistance rates of SBP over a 12-year period.
Methods : We retrospectively analyzed 113 patients who were diagnosed with SBP and in whom ascites cultures were positive between 1996 and 2007. The 12-year period was subdivided into 6-year terms (period A, 1996～2001; and period B, 2002～2007).
Results : One hundred thirteen of 410 cases of SPB had positive ascites cultures. Thirty-seven cases were from period A and 76 cases were from period B. Hospital-acquired SBP was more common during period B. Gram negative microorganisms were isolated from 78% of SBP cases, and the most common microorganism was E.coli (60%). The resistance rates for ampicillin and ciprofloxacin were similar between the two periods, but resistance to cefotaxime was more frequent in period B (3% vs. 26%, p=0.002), and ESBL-producing E.coli was only cultured in period B (0% vs. 32%, p=0.002). Most of the initial antibiotics used were cefotaxime; carbapenem was used as a secondary antibiotic only in period B (0% vs. 55%, p=0.007). ESBL-producing microorganisms were the only predictor of in-hospital mortality based multivariate analysis (OR: 4.14, 95% CI: 1.09-15.07, p=0.037).
Conclusions : No change in pattern of microorganisms in the ascites of patients with SBP was noted during the 12-year period under study, but there was a significant increase in the incidence of hospital-acquired SBP, resistance to cefotaxime, and ESBL-producing E.coli when comparing the outcomes of periods A and B. ESBL-producing microorganisms were the only predictor of in-hospital mortality. (Korean J Med 75:68-76, 2008)

참고자료

· 없음