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Pneumococcal Peritonitis in Adult Patients
Report of 64 Cases With Special Reference to Emergence of Antibiotic Resistance
Olga Capdevila, MD;
Roman Pallares, MD;
Imma Grau, MD;
Fe Tubau, MD;
Josefina Liñares, MD;
Javier Ariza, MD;
Francisco Gudiol, MD
Arch Intern Med. 2001;161:1742-1748.
Background Few data are available regarding pneumococcal peritonitis. We studied
the clinical characteristics of intra-abdominal infections caused by Streptococcus pneumoniae and its prognosis in relation
to antibiotic resistance.
Methods We reviewed all cases of culture-proved pneumococcal peritonitis. Patients
with liver cirrhosis and primary pneumococcal peritonitis were compared with
patients with Escherichia coli peritonitis.
Results Between January 1, 1979, and December 31, 1998, we identified 45 cases
of primary pneumococcal peritonitis in patients with cirrhosis and 19 cases
of secondary (or tertiary) pneumococcal peritonitis. Patients with cirrhosis
and primary pneumococcal peritonitis vs those with primary E coli peritonitis had more frequent community-acquired infection,
73% vs 47%; pneumonia, 36% vs 2%; and bacteremia, 76% vs 33%; and higher attributable
mortality (early mortality), 27% vs 9% (P<.05
for all). Secondary (or tertiary) pneumococcal peritonitis was associated
with upper or lower gastrointestinal tract diseases; in most cases, the infection
appeared after surgery. A hematogenous spread of S pneumoniae from a respiratory tract infection might be the most important origin
of peritonitis; also, S pneumoniae might directly
reach the gastrointestinal tract favored by endoscopic procedures or hypochlorhydria.
There was an increased prevalence of penicillin and cephalosporin resistance
up to 30.7% and 17.0%, respectively, although it was not associated with increased
mortality rates.
Conclusions Primary pneumococcal peritonitis in patients with cirrhosis more often
spread hematogenously from the respiratory tract and was associated with early
mortality. In secondary (and tertiary) pneumococcal peritonitis, a transient
gastrointestinal tract colonization and inoculation during surgery might be
the most important mechanisms. Current levels of resistance were not associated
with increased mortality rates.
From the Infectious Disease Service (Drs Capdevila, Pallares, Grau,
Ariza, and Gudiol) and Microbiology Service (Drs Tubau and Liñares),
Hospital de Bellvitge and University of Barcelona, Barcelona, Spain.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Fatal Pneumococcal Sepsis from a Tuboovarian Abscess
Felz and Apostol
J Am Board Fam Med 2004;17:68-70.
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