Development of Escherichia coli strands resistant to quinolones in stools of patients with liver cirrhosis submitted to selective bowel decontamination

BACKGROUND: Selective intestinal decontamination (SID) with norfloxacin in patients with cirrhosis may promote the development of quinolone-resistant (QR) gram-negative bacteria in stools. It is not known wether this fact may become a predisposing factor for the development of infections due to thes e bacteria. MATERIAL AND METHODS: We designed a prospective study to evaluate the incid ence of Escherichia coli in stools at admission in patients with cirrhosis that had previously received norfloxacin as primary or secondary prophylaxi s of spontaneous bacterial peritonitis (SBP) (group I, n = 28) vs those who did not (group II, n = 55). RESULTS: QR strains of E. coli were observed in 37.5 and in 1.47% of patien ts from groups I and II, respectively (p < 0.001). During admission, 36 pat ients underwent norfloxacin prophylaxis (group Iii), and 40 did not (group IV). Eleven patients from group III and one patient from group IV showed QR E, coli in stools. We observed 5 bacterial infections in group III and 14 in group IV (p = 0.0039). No patient with QR E. coli in stools developed in fections due to this bacteria. CONCLUSION: The incidence of QR E, coli in stools of patients with cirrhosi s is significantly increased in patients previously treated with prophylact ic norfloxacin, However, this fact seems not to be associated with an incre ment in the prevalence of QR E. coli infections.