Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis
Open accessAbstract
The extensive use of invasive procedures and of long-term norfloxacin prophylaxis in the management of cirrhotic patients may have influenced the epidemiology of bacterial infections in cirrhosis. We conducted a prospective evaluation of all bacterial infections diagnosed in patients with cirrhosis in a Liver Unit between April 1998 and April 2000. A total of 405 patients presented 572 bacterial infections in 507 admissions. Spontaneous bacterial peritonitis was the most frequent infection (138 cases). Gram-positive cocci were responsible for 53% of total bacterial infections in the study, being the main bacteria isolated in nosocomial infections (59%). Patients requiring treatment in an intensive care unit and those submitted to invasive procedures presented a higher rate of infections caused by gram-positive cocci (77% vs. 48%, P < .001 and 58% vs. 40%, P < .02, respectively). Fifty percent of culture-positive spontaneous bacterial peritonitis in patients on long-term norfloxacin administration (n = 93) and 16% in patients not receiving this therapy (n = 414) were caused by quinolone-resistant gram-negative bacilli, P = .01. The rate of culture-positive spontaneous bacterial peritonitis caused by trimethoprim-sulfamethoxazole-resistant gram-negative bacilli was also very high in patients on long-term norfloxacin administration (44% vs. 18%, P = .09). In conclusion, infections caused by gram-positive cocci have markedly increased in cirrhosis. This phenomenon may be related to the current high degree of instrumentation of cirrhotic patients. Quinolone-resistant spontaneous bacterial peritonitis constitutes an emergent problem in patients on long-term norfloxacin prophylaxis, with trimethoprim-sulfamethoxazole not being a valid alternative.
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Norfloxacin may be suitable for weeks to months of treatment but not for long-term or life-long use in cirrhosis patients.
“A major problem with the use of norfloxacin is the development of antibiotic resistance110–112, suggesting that it might be suitable for treatment lasting weeks to months but not for long-term or life-long application in patients with cirrhosis.”
From The gut microbiome and liver cancer: mechanisms and clinical translation (2017) · cites this paper as [110]
A major problem with norfloxacin is the development of antibiotic resistance.
“A major problem with the use of norfloxacin is the development of antibiotic resistance110–112, suggesting that it might be suitable for treatment lasting weeks to months but not for long-term or life-long application in patients with cirrhosis.”
From The gut microbiome and liver cancer: mechanisms and clinical translation (2017) · cites this paper as [110]
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- Authors
- Fernández, J., Navasa, M., Gómez, J., Colmenero, J., Vila, J., Arroyo, V., & Rodés, J.
- Affiliations
- Hospital Clínic de Barcelona (ES)
- Corresponding author
- Navasa, Miquel
- Venue
- Hepatology
- Published
- 2002-01
- Volume
- 35
- Issue
- 1
- Pages
- 140-148
- ISSN
- 0270-9139 (ISSN-L)
- OpenAlex
- W2029771605
- Cited by
- 954
- References
- 42
- Citations by year
- 2026: 9 · 2025: 17 · 2024: 25 · 2023: 26 · 2022: 44 · 2021: 38 · 2020: 45 · 2019: 64 · 2018: 59 · 2017: 49 · 2016: 48 · 2015: 58 · 2014: 63 · 2013: 50 · 2012: 58
- FWCI
- 14.74
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Fondo de Investigación Sanitaria (FIS 00/0921)
- Instituto de Salud Carlos III (BEFI 00/9380)
- Hospital Clínic
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
- Keywords
- liver cirrhosis, bacterial infection, spontaneous bacterial peritonitis, Gram-positive cocci, quinolone resistance, trimethoprim-sulfamethoxazole resistance, nosocomial infections, invasive procedures, intensive care unit, antibiotic resistance
- MeSH terms
- Aged, Anti-Infective Agents, Bacterial Infections, Critical Care, Drug Resistance, Microbial, Escherichia coli, Female, Gram-Negative Bacteria, Gram-Positive Cocci, Hepatitis C, Humans, Kidney, Liver, Liver Cirrhosis, Liver Cirrhosis, Alcoholic, Male, Middle Aged, Norfloxacin, Peritonitis, Prospective Studies, Sulfamethoxazole, Trimethoprim
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