Pathogen profile and drug resistance analysis of spontaneous peritonitis in cirrhotic patients

Table 1 Distribution of the major pathogens in the ascites samples of 288 patients with spontaneous bacterial peritonitis between 2011 and 2013 n (%)

Pathogen	Total (n= 306)	Non-nosocomial infection (n= 207)	Nosocomial infection(n= 99)	P value(χ2test)
Gram-negative bacteria	178 (58.2)	113 (54.6)	65 (65.7)	0.06
Escherichia coli	74 (24.2)	50 (24.1)	24 (24.2)	0.98
Klebsiella pneumoniae	58 (18.9)	39 (18.8)	19 (19.1)	0.94
Acinetobacter spp.	10 (3.3)	2 (0.9)	8 (8.1)	0.001
Pseudomonas aeruginosa	9 (2.9)	2 (0.9)	7 (7.1)	0.003
Enterobacter cloacae	17 (5.6)	12 (5.8)	5 (5.1)	0.79
Aerogenes spp.	10 (3.3)	8 (3.9)	2 (2.0)	0.39
Gram-positive bacteria	85 (27.8)	58 (28.0)	27 (27.3)	0.89
Enterococcus	34 (11.1)	22 (10.6)	12 (12.1)	0.69
Staphylococcus aureus	23 (7.5)	16 (7.7)	7 (7.1)	0.83
Coagulase-negative staphylococci	17 (5.6)	12 (5.8)	5 (5.1)	0.79
Streptococcus pneumoniae	11 (3.6)	8 (3.9)	3 (3.0)	0.71
Fungi	9 (2.9)	2 (0.9)	7 (7.1)	0.004

P < 0.05 was considered statistically significant.

Table 2 Drug resistance rate of major gram-negative bacteria to commonly used antibacterial agents

Antibacterial agents	Escherichia coli (n = 74)		Klebsiella pneumoniae (n = 58)		Acinetobacter spp (n = 10)		Pseudomonas aeruginosa(n = 9)
	Strains	Drug resistance rate (%)	Strains	Drug resistance rate (%)	Strains	Drug resistance rate (%)	Strains	Drug resistance rate (%)
Ampicillin/sulbactam	30	40.5	23	39.7	8	80	7	77.8
Piperacillin/tazobactam	7	9.4	8	13.8	6	60	3	33.3
Ceftriaxone	18	24.3	20	34.5	8	80	9	100
Cefepime	31	41.9	15	25.9	7	70	3	33.3
Cefoperazone/sulbactam	12	16.2	17	29.3	4	40	3	33.3
Ceftazidime	33	44.6	17	29.3	7	70	3	33.3
Amikacin	5	6.8	3	5.1	2	20	1	11.1
Gentamicin	37	50	12	20.7	6	60	2	22.2
Ciprofloxacin	37	50	16	27.6	7	70	3	33.3
Aztreonam	26	35.1	13	22.4	6	60	4	44.4
Imipenem	1	1.3	7	12.1	6	60	3	33.3
Meropenem	2	2.7	4	6.9	7	70	2	22.2

Table 3 Comparison of the drug resistance of Escherichia coli to commonly used antibacterial agents between nosocomial and non-nosocomial spontaneous bacterial peritonitis n (%)

Antibacterial agents	Non-nosocomial infections (n = 50)	Nosocomial infections (n = 24)	P value (χ2test)
ESBL test	19 (38.0)	15 (62.5)	0.013
Ampicillin/sulbactam	11 (28.0)	12 (66.7)	0.093
Piperacillin/tazobactam	2 (4.0)	5 (20.8)	0.021
Ceftriaxone	7 (14.0)	11 (45.8)	< 0.001
Cefepime	17 (34.0)	14 (58.3)	0.04
Cefoperazone/sulbactam	4 (8.0)	8 (33.3)	0.006
Ceftazidime	16 (32.0)	17 (70.8)	0.002
Amikacin	2 (4.0)	3 (12.5)	0.173
Gentamicin	17 (34.0)	20 (83.3)	< 0.001
Ciprofloxacin	18 (36.0)	19 (79.1)	0.001
Aztreonam	11 (22.0)	15 (62.5)	0.001
Imipenem	1 (2.0)	0 (0)	0.485
Meropenem	0 (0)	2 (8.3)	0.039

ESBL test: Extended-spectrum β-lactamase test. P < 0.05 was considered statistically significant.

Table 4 Comparison of the drug resistance of Klebsiella pneumoniae to commonly used antibacterial agents between nosocomial and non-nosocomial spontaneous bacterial peritonitis n (%)

Antibacterial agents	Non-nosocomial infections(n = 39)	Nosocomial infections(n = 19)	P value (χ2test)
ESBL test	5 (12.8)	7 (36.8)	0.034
Ampicillin/sulbactam	11 (28.2)	12 (63.1)	0.011
Piperacillin/tazobactam	3 (7.7)	5 (26.3)	0.054
Ceftriaxone	9 (23.1)	11 (57.9)	0.009
Cefepime	8 (20.1)	7 (36.8)	0.183
Cefoperazone/sulbactam	8 (20.1)	9 (47.4)	0.035
Ceftazidime	10 (25.6)	7 (36.8)	0.098
Amikacin	2 (5.1)	1 (5.3)	0.983
Gentamicin	5 (12.8)	7 (36.8)	0.034
Ciprofloxacin	10 (25.6)	6 (31.6)	0.635
Aztreonam	8 (20.1)	5 (26.3)	0.619
Imipenem	4 (10.3)	3 (15.8)	0.544
Meropenem	2 (5.10)	2 (10.5)	0.446

ESBL test: Extended-spectrum β-lactamase test. P < 0.05 was considered statistically significant.

Table 5 Drug resistance rate of the major gram-positive bacteria against commonly used antibacterial agents

Antibacterial agents	Enterococcus (n = 34)		Staphylococcus aureus(n = 23)		Coagulase-negative staphylococci(n = 17)		Streptococcus pneumoniae(n = 11)
	Strains	Drug resistance rate (%)	Strains	Drug resistance rate (%)	Strains	Drug resistance rate (%)	Strains	Drug resistance rate (%)
Penicillin	26	76.5	21	91.3	15	88.2	10	90.9
Oxacillin	23	67.6	12	52.2	13	76.5	7	63.3
Erythromycin	19	55.9	14	60.9	12	70.6	8	72.7
Cefazolin	25	73.5	13	56.5	10	58.8	7	63.3
Nitrofurantoin	18	52.9	2	8.7	1	5.9	2	18.1
Rifampicin	5	14.7	3	13.0	2	11.8	1	9.1
Clindamycin	8	23.5	6	26.1	6	35.3	4	36.4
Levofloxacin	28	82.4	10	43.4	7	41.2	4	36.4
Ciprofloxacin	26	76.5	11	47.8	8	47.1	6	54.5
Gentamicin	10	29.4	3	13.0	4	23.5	2	18.1
Moxifloxacin	14	41.1	9	39.1	5	29.4	2	18.1
Vancomycin	2	5.9	0	0	0	0	0	0

Table 6 Comparison of the drug resistance of Enterococcus species to commonly used antibacterial agents between nosocomial and non-nosocomial spontaneous bacterial peritonitis n (%)

Antibacterial agents	Non-nosocomial infections (n = 22)	Nosocomial infections (n = 12)	P value (χ2test)
Penicillin	16 (72.7)	10 (83.3)	0.486
Oxacillin	14 (63.6)	9 (75.0)	0.498
Erythromycin	10 (45.5)	9 (75.0)	0.097
Cefazolin	14 (63.6)	11 (91.7)	0.077
Nitrofurantoin	8 (36.4)	10 (83.3)	0.009
Rifampicin	3 (13.6)	2 (16.7)	0.812
Clindamycin	5 (22.7)	3 (25.0)	0.881
Levofloxacin	18 (81.8)	10 (83.3)	0.912
Ciprofloxacin	18 (81.8)	8 (66.7)	0.320
Gentamicin	4 (18.2)	6 (50.0)	0.052
Moxifloxacin	7 (31.8)	7 (58.3)	0.133
Vancomycin	1 (4.5)	1 (8.3)	0.645

P < 0.05 was considered statistically significant.

Table 7 Comparison of the drug resistance of Staphylococcus aureus to commonly used antibacterial agents between nosocomial and non-nosocomial spontaneous bacterial peritonitis n (%)

Antibacterial agents	Non-nosocomial infections (n = 16)	Nosocomial infections (n = 7)	P value (χ2test)
Penicillin	15 (93.8)	6 (85.7)	0.529
Oxacillin	6 (37.5)	6 (85.7)	0.033
Erythromycin	9 (56.3)	5 (71.4)	0.493
Cefazolin	8 (50.0)	5 (71.4)	0.340
Nitrofurantoin	2 (12.5)	0 (0)	0.328
Rifampicin	2 (12.5)	1 (4.3)	0.907
Clindamycin	2 (12.5)	4 (57.1)	0.025
Levofloxacin	4 (25.0)	6 (85.7)	0.007
Ciprofloxacin	5 (31.3)	6 (85.7)	0.016
Gentamicin	2 (12.5)	1 (4.3)	0.907
Moxifloxacin	3 (18.6)	6 (85.7)	0.002
Vancomycin	0 (0)	0 (0)	NS

P < 0.05 was considered statistically significant; NS: Not significant.