Genetic background of Escherichia coli isolates from patients with spontaneous bacterial peritonitis: relationship with host factors and prognosis

被引:19
作者
Bert, F. [1 ]
Panhard, X. [2 ]
Johnson, J. [3 ,4 ]
Lecuyer, H. [1 ]
Moreau, R. [5 ]
Le Grand, J. [6 ]
Johnston, B. [3 ,4 ]
Sinegre, M. [6 ]
Valla, D. [5 ,7 ,8 ]
Nicolas-Chanoine, M. -H. [1 ,5 ,8 ]
机构
[1] Hop Beaujon, Microbiol Serv, AP HP, F-92110 Clichy, France
[2] Hop Bichat Claude Bernard, AP HP, UF Biostat, F-75877 Paris, France
[3] Univ Minnesota, Vet Affairs Med Ctr, Minneapolis, MN USA
[4] Univ Minnesota, Dept Med, Minneapolis, MN USA
[5] Ctr Rech Biomed Bichat Beaujon, INSERM, U773, Clichy, France
[6] Hop Beaujon, Serv Pharm, AP HP, F-92110 Clichy, France
[7] Hop Beaujon, Serv Hepatol, AP HP, F-92110 Clichy, France
[8] Univ Paris, Fac Med D Diderot, F-75252 Paris, France
关键词
Cirrhosis; Escherichia coli; fluoroquinolone; mortality; phylogenetic group; spontaneous bacterial peritonitis; virulence factor;
D O I
10.1111/j.1469-0691.2008.02088.x
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Spontaneous bacterial peritonitis (SBP) is a severe complication in patients with cirrhosis and ascites. It is predominantly caused by Escherichia coli. The phylogenetic group and virulence genotype of E. coli isolates causing SBP were investigated, and the association of these characteristics with host factors and prognosis was examined. Seventy-six episodes of E. coli SBP that occurred over a 9-year period were studied. The phylogenetic group of the isolates and the presence of 36 virulence factor genes were investigated. The influence of bacterial and host factors on in-hospital mortality was assessed by multiple logistic regression. Phylogenetic groups A, B1, B2 and D were found in 26%, 4%, 46% and 24% of the isolates, respectively. Virulence factor genes were more frequent in B2 isolates than in non-B2 isolates (mean virulence score 15.4 vs. 7.3, p < 10(-4)). Ciprofloxacin resistance was significantly associated with non-B2 groups and a low virulence score. Host factors independently associated with a shift from B2 to non-B2 isolates were norfloxacin prophylaxis (OR 13.01, p 0.0213) and prothrombin ratio (OR 1.04 for a 10% decrease, p 0.0211). The model for end-stage liver disease (MELD) score (OR 1.83, p 0.0007) and hospital-acquired SBP (OR 4.13, p 0.0247) were independent predictors of in-hospital mortality. In contrast, outcome was not influenced by the phylogenetic group or the virulence profile. These findings indicate that the characteristics of E. coli isolates causing SBP vary with the severity of liver disease and with fluoroquinolone prophylaxis. Host factors are more important than bacterial factors in predicting in-hospital mortality.
引用
收藏
页码:1034 / 1040
页数:7
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