Development of quinolone-resistant strains of Escherichia coli in stools of patients with cirrhosis undergoing norfloxacin prophylaxis:: clinical consequences

Background/Aim: Norfloxacin prophylaxis decreases the incidence of bacterial infections in high-risk cirrhotic patients, but may promote the development of quinolone-resistant gram-negative bacteria in stools, and eventually lead to infections due to these bacteria. The aim of the study was to evaluate the prevalence of quinolone-resistant strains of E.coli in stools on admission, and the characteristics of any nosocomial infections. Methods: Eighty-three consecutively hospitalized cirrhotic patients were included in this prospective study, The presence of quinolone-resistant strains of E.coli in stools on admission, and the characteristics of any nosocomial infections were recorded. Results: Fourteen out of 83 patients (16.8%) showed quinolone-resistant E.coli in stools (Group I), and 69 did not (Group II). Thirteen out of 14 from Group I (92.8%) and 17/69 (24.6) from Group II had received primary or secondary prophylaxis with norfloxacin (p<0.001), During hospitalization, 12/12 (100%) of patients from Group I and 25/66 (37.8%) of patients from Group II underwent norfloxacin prophylaxis. Three bacterial infections in patients from Group I, 3 from Group II patients receiving norfloxacin and 16 from Group II patients not receiving norfloxacin were recorded (p<0.05). No infections due to quinolone-resistant E.coli were observed in patients colonized with these bacteria. Treatment with norfloxacin induced the development of quinolone-resistant E.coli in 6/14 (42.8%) patients in a mean time of 18.5+/-9.8 days. Conclusions: The development of quinolone-resistant strains of E.coli is significantly associated with previous administration of norfloxacin prophylaxis. However, in our series this fact is not associated with an increased incidence of quinolone-resistant E.coli or other gram-negative infections.