Abstract
Aims : In this study in cirrhosis patients having spontaneous ascites infection (SAI) the investigation of the activity of cefepime being a fourth generation cephalosporin was aimed. Method : 19 patients diagnosed as cirrhosis and having acid infection were taken into the study. Cefepime doses were given to all patients having SAI by adjusting according to the clearance of creatinine, in intervals of 12 hours, in 2 gram as parenterally. Cell counting was made in acid liquid on the 1st, 3rd and 5th days. In the patients who had reproduction in acid liquid culture, antibiogram was made with cefepime and other antibiotics. Result : Age average of patients was 55 years (between 42-73 years). Cirrhosis was secondary to hepatitis B virus infection in 10 patients, to hepatitis C virus infection in 7 patients and to autoimmune hepatitis in 2 patients. On the first day the average cell number in the ascites was 5077/mm3 (between 530-12400/mm3), PMNL number was 3861/mm3 (between 320-9600/mm3). On the third day the average cell number in the ascites was 1847/mm3 (between 300-7680/mm3) and PMNL number was 1025/mm3 (between 120-3840/mm3) (p< 0.001). Fifth day ascites liquid the average cell number was 548/mm3 (between 160--1600/mm3) and PMNL number was 267/mm3 (between 80-620/mm3) (p< 0.001). The cefepime resistance in antibiogram was observed only on one patient against E.coli strain. Conclusions: Cefepime, which is a fourth generation cephalosropin, was found out effective in SAI developing on cirrhotic ground.
Highlights
Ascites is defined as pathological liquid accumulation in peritoneum cavity [1]
Cirrhosis was secondary to hepatitis B virus infection in 10 patients, to hepatitis C virus infection in 7 patients and to autoimmune hepatitis in 2 patients
Cefepime, which is a fourth generation cephalosropin, was found out effective in spontaneous ascites infection (SAI) developing on cirrhotic ground
Summary
Ascites is defined as pathological liquid accumulation in peritoneum cavity [1]. Ascites infection in that it is not surgically determined a treatable abdominal infection focal is called spontaneous ascites infection (SAI) [2]. Within one year two of every three cirrhosis patient having SAI is caught again by the infection and their mortality increases (240%) [4,5]. Since in cirrhotic patients the ascites culture positivity has quite decreased in consequence of long term use of antibiotic prophylaxes and irregular antibiotic use, that polymorphonuclear leukocyte (PMNL) number is above 250/mm is adequate for diagnosing SAI [9]. It is seen that in the world in patients being bacteraemia the Enterobacter and Klebsiella group bacteria among enteric bacteria dominate E.coli increasingly and the resistance in increasing ratios is detected [15,16]. In this study it was aimed to determine the effect of cefepime, which has gram-positive effect but especially gram-negative effect and is a fourth generation cephalosporin, and contribute to the literature
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