RESUMO
Spontaneous bacterial peritonitis [SBP] is a bacterial infection of ascitic fluid, which is a frequent and severe complication of hepatic cirrhosis. A vast majority of such infections are due to enteric Gram-negative bacteria, mainly Enterobacteriaceae. The prevalence of extended spectrum beta-lactamases [ESBLs]-producing bacteria is clearly increasing, and in many parts of the world 10-40% of strains of Escherichia coli and Klebsiella pneumoniae express ESBLs. This study was conducted to detect the impact of pattern of antibiotic resistant in our community, especially ESBLs-producing E. coli and K. pneumoniae, on the outcome of SBP caused by these bacteria. Ascitic fluid samples were collecting from 52 proved cases with cirrhotic ascites complicated by SBP for examination and culture [bedside inoculation into blood-culture bottles was done]. Also, antibiotics sensitivity tests were performed. Potential ESBLs producers were subjected to detection of ESBLs by three dimensional method and Oxoid combination test [CDO2]. Positive cultures were obtained in 43 [82.7%] of examined cases, among them 40 [93%] had Gram negative bacteria [32 [80%] E.coli and 8 [20%] K. pneumoniae] and the others [7%] were Gram positive [S.aureus]. Patients with negative or Gram positive cultures were excluded from this study, and these with Gram negative one were treated and followed up until discharge or in-hospital mortality. About 27.5% of studied Gram negative isolates were ESBLs- producing [25% of E.coli and 37.5% of K.pneumoniae]. There was no statistically significant difference between three dimensional method and Oxoid combination test [CDO2] in detection of ESBLs [P>0.05]. The percentages of resistant E.coli and K.pneumoniae respectively were [43.75% and 25%] to cefotaxime, [46.9% and 25%] to ceftriaxone, [50% and 50%] to ceftazidime, [53.1% and 75%] to cotrimoxazole, [50% and 62.5%] to norfloxacin and [12.5% and 50%] to ciprofloxacin. In-hospital mortality due to SBP was 60%. After uni- and multivariate analyses, only 5 variables studied were independently associated with SBP in-hospital mortality [P<0.05]. These were: Child-Pugh score >12 [RR=3.2], having hepatic encephalopathy [RR=2.7], jaundice [RR=1.5], SBP caused by ESBLs-producing strains [RR=1.5] and serum Na<130 mmol/L [RR=1.3]. In conclusion, Gram negative SBP induced by ESBLs- producing strains -which are resistant to all 3rd generation cephalosporin and lead to abundant mortality - are prevalent and must be put in mind . Repeated check up of the pattern of resistance of these strains is indicated and searching for new alternative effective therapy for this treatable severe complication of cirrhosis is recommended. Oxoid combination test is sensitive, convenient and inexpensive method for detection of ESBLs producing organisms