Infections caused by Escherichia coli resistant to norfloxacin in hospitalized cirrhotic patients

Selective intestinal decontamination with norfloxacin is useful to prevent bacterial infections in several groups of cirrhotic patients at high risk o f infection. However, the emergence of infections caused by Escherichia col i resistant to quinolones has recently been observed in cirrhotic patients undergoing prophylactic norfloxacin. Our aim is to determine the characteri stics of the infections caused by E. coli resistant to norfloxacin in hospi talized cirrhotic patients. One hundred and six infections caused by E. col i in 99 hospitalized cirrhotic patients were analyzed and distributed into two groups: group I(n = 67), infections caused by E. coli sensitive to norf loxacin, and group II (n = 39), infections caused by E. coli resistant to n orfloxacin. The clinical and analytical characteristics at diagnosis of the infection were similar in both groups. Previous prophylaxis with norfloxac in was more frequent in group II (15/67, 22.4% vs. 32/39, 82%, P <.0001), a s a result of a higher number of patients submitted to continuous long-term prophylaxis in this group, whereas previous short-term prophylaxis was sim ilar in both groups. Infections were more frequently nosocomial-acquired in group II than in group I (17/67, 25.3% vs. 20/39, 51.2%, P = .01). The typ e of infections was similar in both groups: urinary tract infections 38 in group I and 24 in group II, spontaneous bacterial peritonitis 8 and 2, spon taneous bacteremia 4 and 4, and bacterascites 1 and 0, respectively (pNS). Mortality during hospitalization was similar in the two groups (4/67, 5.9% vs. 5/39, 12.8%, pNS). None of the E. coli resistant to norfloxacin were al so resistant to cefotaxime and only one of them was resistant to amoxicilli n-clavulanic acid. Prophylaxis with norfloxacin, usually continuous long-te rm prophylaxis, favors the development of infections caused by norfloxacin- resistant E. coli. Long-term antibiotic prophylaxis should therefore be res tricted to highly selected groups of cirrhotic patients at high-risk of inf ection. Infections caused by E. call resistant to norfloxacin show a severi ty similar to those caused by sensitive E. coli. No significant associated resistance between norfloxacin and the antibiotics most frequently used in the treatment of bacterial infections in cirrhotic patients has been observ ed.