The Experts below are selected from a list of 273 Experts worldwide ranked by ideXlab platform
Montserrat Andreu - One of the best experts on this subject based on the ideXlab platform.
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infections caused by escherichia coli resistant to Norfloxacin in hospitalized cirrhotic patients
Hepatology, 1999Co-Authors: Jordi Ortiz, Maria Carme Vila, M German D Soriano, Josep Minana, Jordi Gana, Beatriz Mirelis, Maria Teresa Novella, Susana Coll, Miriam Sabat, Montserrat AndreuAbstract:: Selective intestinal decontamination with Norfloxacin is useful to prevent bacterial infections in several groups of cirrhotic patients at high risk of infection. However, the emergence of infections caused by Escherichia coli resistant to quinolones has recently been observed in cirrhotic patients undergoing prophylactic Norfloxacin. Our aim is to determine the characteristics of the infections caused by E. coli resistant to Norfloxacin in hospitalized cirrhotic patients. One hundred and six infections caused by E. coli in 99 hospitalized cirrhotic patients were analyzed and distributed into two groups: group I (n = 67), infections caused by E. coli sensitive to Norfloxacin, and group II (n = 39), infections caused by E. coli resistant to Norfloxacin. The clinical and analytical characteristics at diagnosis of the infection were similar in both groups. Previous prophylaxis with Norfloxacin was more frequent in group II (15/67, 22.4% vs. 32/39, 82%, P <.0001), as a result of a higher number of patients submitted to continuous long-term prophylaxis in this group, whereas previous short-term prophylaxis was similar 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 type 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, spontaneous 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 also resistant to cefotaxime and only one of them was resistant to amoxicillin-clavulanic acid. Prophylaxis with Norfloxacin, usually continuous long-term prophylaxis, favors the development of infections caused by Norfloxacin-resistant E. coli. Long-term antibiotic prophylaxis should therefore be restricted to highly selected groups of cirrhotic patients at high-risk of infection. Infections caused by E. coli resistant to Norfloxacin show a severity 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 observed.
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continuous versus inpatient prophylaxis of the first episode of spontaneous bacterial peritonitis with Norfloxacin
Hepatology, 1997Co-Authors: Maria Teresa Novella, Jordi Ortiz, Jordi Gana, Miriam Sabat, Montserrat Andreu, R Sola, German Soriano, Susanna Coll, Maria Vila, C GuarnerAbstract:Cirrhotic patients with ascites and low ascitic fluid total protein and/or high serum bilirubin levels are at high risk to develop the first episode of spontaneous bacterial peritonitis during long-term follow-up. The aim of the present study was to determine the efficacy of continuous long-term selective intestinal decontamination with Norfloxacin in the prevention of this complication. One hundred nine cirrhotic patients with ascites and ascitic fluid total protein levels of ⩽ 1 g/dL or serum bilirubin levels of > 2.5 mg/dL without previous spontaneous bacterial peritonitis were prospectively randomized into two groups: group 1 (n = 56) received Norfloxacin, 400 mg daily administered orally, and group 2 (n = 53) was the long-term control group, receiving Norfloxacin only during hospitalization. During a mean follow-up of 43 +/- 3 weeks, there was one spontaneous bacterial peritonitis (1.8%) in group 1 and 9 (16.9%) in group 2 (P < .01). The incidence of community-acquired spontaneous bacterial peritonitis was lower in group 1 (1.8% vs. 13.2%, P < .05), whereas the incidence of nosocomial spontaneous bacterial peritonitis (0% vs. 3.7%) and the incidence of extraperitoneal infections (25% vs. 24.5%) were similar in both groups (P = NS). The actuarial probability of survival at 18 months was 75% in group 1 and 62% in group 2 (P = NS). Resistance to Norfloxacin was observed in 9 of 10 (90%) Escherichia coli isolated in infections from group 1 and in 4 of 11 (36.3%) from group 2 (P < .05). The overall incidence of infections caused by Norfloxacin-resistant bacteria was higher in group 1 (19.6% vs. 15%), but it did not reach statistical significance. Continuous long-term selective intestinal decontamination with Norfloxacin is effective in preventing the first spontaneous bacterial peritonitis in cirrhotic patients at high risk. However, the emergence of infections caused by Norfloxacin-resistant bacteria must be weighed carefully against the benefits of continuous long-term prophylaxis.
R Planas - One of the best experts on this subject based on the ideXlab platform.
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Norfloxacin vs ceftriaxone in the prophylaxis of infections in patients with advanced cirrhosis and hemorrhage
Gastroenterology, 2006Co-Authors: J Fernandez, Luis Ruiz Del Arbol, C Gomez, Rosa Durandez, Regina Serradilla, Carlos Guarner, R Planas, Vicente Arroyo, Miguel NavasaAbstract:Background & Aims: Oral Norfloxacin is the standard of therapy in the prophylaxis of bacterial infections in cirrhotic patients with gastrointestinal hemorrhage. However, during the last years, the epidemiology of bacterial infections in cirrhosis has changed, with a higher incidence of infections caused by quinolone-resistant bacteria. This randomized controlled trial was aimed to compare oral Norfloxacin vs intravenous ceftriaxone in the prophylaxis of bacterial infection in cirrhotic patients with gastrointestinal bleeding. Methods: One hundred eleven patients with advanced cirrhosis (at least 2 of the following: ascites, severe malnutrition, encephalopathy, or bilirubin >3 mg/dL) and gastrointestinal hemorrhage were randomly treated with oral Norfloxacin (400 mg twice daily; n=57) or intravenous ceftriaxone (1 g/day; n=54) for 7 days. The end point of the trial was the prevention of bacterial infections within 10 days after inclusion. Results: Clinical data were comparable between groups. The probability of developing proved or possible infections, proved infections, and spontaneous bacteremia or spontaneous bacterial peritonitis was significantly higher in patients receiving Norfloxacin (33% vs 11%, P = .003; 26% vs 11%, P = .03; and 12% vs 2%, P = .03, respectively). The type of antibiotic used (Norfloxacin), transfusion requirements at inclusion, and failure to control bleeding were independent predictors of infection. Seven gram-negative bacilli were isolated in the Norfloxacin group, and 6 were quinolone resistant. Nonenterococcal streptococci were only isolated in the Norfloxacin group. No difference in hospital mortality was observed between groups. Conclusions: Intravenous ceftriaxone is more effective than oral Norfloxacin in the prophylaxis of bacterial infections in patients with advanced cirrhosis and hemorrhage.
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Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis results of a double blind placebo controlled trial
Hepatology, 1990Co-Authors: Pere Gines, R Planas, Antoni Rimola, Victor Vargas, Francesc Marco, M Almela, Montserrat Forne, Maria Luisa Miranda, Josep Llach, Joan M SalmeronAbstract:Eighty cirrhotic patients who had recovered from an episode of spontaneous bacterial peritonitis were included in a multicenter, double-blind trial aimed at comparing long-term Norfloxacin administration (400 mg/day; 40 patients) vs. placebo (40 patients) in the prevention of spontaneous bacterial peritonitis recurrence. At entry, both groups were similar with respect to clinical and laboratory data, ascitic fluid protein and polymorphonuclear concentrations, number of previous episodes of spontaneous bacterial peritonitis and causative organisms of the index spontaneous bacterial peritonitis. Norfloxacin administration produced a selective intestinal decontamination (elimination of aerobic gram-negative bacilli from the fecal flora without significant changes in other microorganisms) throughout the study in six patients in whom the effect of Norfloxacin on the fecal flora was periodically assessed. Fourteen patients from the placebo group (35%) and five from the Norfloxacin group (12%) developed spontaneous bacterial peritonitis recurrence during follow-up (χ2 = 5.97; p = 0.014) (mean follow-up period = 6.4 ± 0.6 mo; range = 1 to 19 mo). Ten of the 14 spontaneous bacterial peritonitis recurrences in the placebo group and only one of the five spontaneous bacterial peritonitis recurrences in the Norfloxacin group were caused by aerobic gramnegative bacilli (χ2 = 8.87; p = 0.0029). The overall probability of spontaneous bacterial peritonitis recurrence at 1 yr of follow-up was 20% in the Norfloxacin group and 68% in the placebo group (p = 0.0063) and the probability of spontaneous bacterial peritonitis recurrence caused by aerobic gram-negative bacilli at 1 yr of follow-up was 3% and 60%, respectively (p = 0.0013). Only one patient treated with Norfloxacin experienced side effects related to treatment (oral and esophageal candidiasis). These results indicate that long-term selective intestinal decontamination with Norfloxacin is an effective and safe measure to prevent spontaneous bacterial peritonitis recurrence caused by aerobic gram-negative bacilli in cirrhosis. (HEPATOLOGY 1990;12:716–724).
Jordi Ortiz - One of the best experts on this subject based on the ideXlab platform.
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infections caused by escherichia coli resistant to Norfloxacin in hospitalized cirrhotic patients
Hepatology, 1999Co-Authors: Jordi Ortiz, Maria Carme Vila, M German D Soriano, Josep Minana, Jordi Gana, Beatriz Mirelis, Maria Teresa Novella, Susana Coll, Miriam Sabat, Montserrat AndreuAbstract:: Selective intestinal decontamination with Norfloxacin is useful to prevent bacterial infections in several groups of cirrhotic patients at high risk of infection. However, the emergence of infections caused by Escherichia coli resistant to quinolones has recently been observed in cirrhotic patients undergoing prophylactic Norfloxacin. Our aim is to determine the characteristics of the infections caused by E. coli resistant to Norfloxacin in hospitalized cirrhotic patients. One hundred and six infections caused by E. coli in 99 hospitalized cirrhotic patients were analyzed and distributed into two groups: group I (n = 67), infections caused by E. coli sensitive to Norfloxacin, and group II (n = 39), infections caused by E. coli resistant to Norfloxacin. The clinical and analytical characteristics at diagnosis of the infection were similar in both groups. Previous prophylaxis with Norfloxacin was more frequent in group II (15/67, 22.4% vs. 32/39, 82%, P <.0001), as a result of a higher number of patients submitted to continuous long-term prophylaxis in this group, whereas previous short-term prophylaxis was similar 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 type 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, spontaneous 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 also resistant to cefotaxime and only one of them was resistant to amoxicillin-clavulanic acid. Prophylaxis with Norfloxacin, usually continuous long-term prophylaxis, favors the development of infections caused by Norfloxacin-resistant E. coli. Long-term antibiotic prophylaxis should therefore be restricted to highly selected groups of cirrhotic patients at high-risk of infection. Infections caused by E. coli resistant to Norfloxacin show a severity 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 observed.
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continuous versus inpatient prophylaxis of the first episode of spontaneous bacterial peritonitis with Norfloxacin
Hepatology, 1997Co-Authors: Maria Teresa Novella, Jordi Ortiz, Jordi Gana, Miriam Sabat, Montserrat Andreu, R Sola, German Soriano, Susanna Coll, Maria Vila, C GuarnerAbstract:Cirrhotic patients with ascites and low ascitic fluid total protein and/or high serum bilirubin levels are at high risk to develop the first episode of spontaneous bacterial peritonitis during long-term follow-up. The aim of the present study was to determine the efficacy of continuous long-term selective intestinal decontamination with Norfloxacin in the prevention of this complication. One hundred nine cirrhotic patients with ascites and ascitic fluid total protein levels of ⩽ 1 g/dL or serum bilirubin levels of > 2.5 mg/dL without previous spontaneous bacterial peritonitis were prospectively randomized into two groups: group 1 (n = 56) received Norfloxacin, 400 mg daily administered orally, and group 2 (n = 53) was the long-term control group, receiving Norfloxacin only during hospitalization. During a mean follow-up of 43 +/- 3 weeks, there was one spontaneous bacterial peritonitis (1.8%) in group 1 and 9 (16.9%) in group 2 (P < .01). The incidence of community-acquired spontaneous bacterial peritonitis was lower in group 1 (1.8% vs. 13.2%, P < .05), whereas the incidence of nosocomial spontaneous bacterial peritonitis (0% vs. 3.7%) and the incidence of extraperitoneal infections (25% vs. 24.5%) were similar in both groups (P = NS). The actuarial probability of survival at 18 months was 75% in group 1 and 62% in group 2 (P = NS). Resistance to Norfloxacin was observed in 9 of 10 (90%) Escherichia coli isolated in infections from group 1 and in 4 of 11 (36.3%) from group 2 (P < .05). The overall incidence of infections caused by Norfloxacin-resistant bacteria was higher in group 1 (19.6% vs. 15%), but it did not reach statistical significance. Continuous long-term selective intestinal decontamination with Norfloxacin is effective in preventing the first spontaneous bacterial peritonitis in cirrhotic patients at high risk. However, the emergence of infections caused by Norfloxacin-resistant bacteria must be weighed carefully against the benefits of continuous long-term prophylaxis.
Maria Teresa Novella - One of the best experts on this subject based on the ideXlab platform.
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infections caused by escherichia coli resistant to Norfloxacin in hospitalized cirrhotic patients
Hepatology, 1999Co-Authors: Jordi Ortiz, Maria Carme Vila, M German D Soriano, Josep Minana, Jordi Gana, Beatriz Mirelis, Maria Teresa Novella, Susana Coll, Miriam Sabat, Montserrat AndreuAbstract:: Selective intestinal decontamination with Norfloxacin is useful to prevent bacterial infections in several groups of cirrhotic patients at high risk of infection. However, the emergence of infections caused by Escherichia coli resistant to quinolones has recently been observed in cirrhotic patients undergoing prophylactic Norfloxacin. Our aim is to determine the characteristics of the infections caused by E. coli resistant to Norfloxacin in hospitalized cirrhotic patients. One hundred and six infections caused by E. coli in 99 hospitalized cirrhotic patients were analyzed and distributed into two groups: group I (n = 67), infections caused by E. coli sensitive to Norfloxacin, and group II (n = 39), infections caused by E. coli resistant to Norfloxacin. The clinical and analytical characteristics at diagnosis of the infection were similar in both groups. Previous prophylaxis with Norfloxacin was more frequent in group II (15/67, 22.4% vs. 32/39, 82%, P <.0001), as a result of a higher number of patients submitted to continuous long-term prophylaxis in this group, whereas previous short-term prophylaxis was similar 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 type 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, spontaneous 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 also resistant to cefotaxime and only one of them was resistant to amoxicillin-clavulanic acid. Prophylaxis with Norfloxacin, usually continuous long-term prophylaxis, favors the development of infections caused by Norfloxacin-resistant E. coli. Long-term antibiotic prophylaxis should therefore be restricted to highly selected groups of cirrhotic patients at high-risk of infection. Infections caused by E. coli resistant to Norfloxacin show a severity 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 observed.
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continuous versus inpatient prophylaxis of the first episode of spontaneous bacterial peritonitis with Norfloxacin
Hepatology, 1997Co-Authors: Maria Teresa Novella, Jordi Ortiz, Jordi Gana, Miriam Sabat, Montserrat Andreu, R Sola, German Soriano, Susanna Coll, Maria Vila, C GuarnerAbstract:Cirrhotic patients with ascites and low ascitic fluid total protein and/or high serum bilirubin levels are at high risk to develop the first episode of spontaneous bacterial peritonitis during long-term follow-up. The aim of the present study was to determine the efficacy of continuous long-term selective intestinal decontamination with Norfloxacin in the prevention of this complication. One hundred nine cirrhotic patients with ascites and ascitic fluid total protein levels of ⩽ 1 g/dL or serum bilirubin levels of > 2.5 mg/dL without previous spontaneous bacterial peritonitis were prospectively randomized into two groups: group 1 (n = 56) received Norfloxacin, 400 mg daily administered orally, and group 2 (n = 53) was the long-term control group, receiving Norfloxacin only during hospitalization. During a mean follow-up of 43 +/- 3 weeks, there was one spontaneous bacterial peritonitis (1.8%) in group 1 and 9 (16.9%) in group 2 (P < .01). The incidence of community-acquired spontaneous bacterial peritonitis was lower in group 1 (1.8% vs. 13.2%, P < .05), whereas the incidence of nosocomial spontaneous bacterial peritonitis (0% vs. 3.7%) and the incidence of extraperitoneal infections (25% vs. 24.5%) were similar in both groups (P = NS). The actuarial probability of survival at 18 months was 75% in group 1 and 62% in group 2 (P = NS). Resistance to Norfloxacin was observed in 9 of 10 (90%) Escherichia coli isolated in infections from group 1 and in 4 of 11 (36.3%) from group 2 (P < .05). The overall incidence of infections caused by Norfloxacin-resistant bacteria was higher in group 1 (19.6% vs. 15%), but it did not reach statistical significance. Continuous long-term selective intestinal decontamination with Norfloxacin is effective in preventing the first spontaneous bacterial peritonitis in cirrhotic patients at high risk. However, the emergence of infections caused by Norfloxacin-resistant bacteria must be weighed carefully against the benefits of continuous long-term prophylaxis.
Joan M Salmeron - One of the best experts on this subject based on the ideXlab platform.
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Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis results of a double blind placebo controlled trial
Hepatology, 1990Co-Authors: Pere Gines, R Planas, Antoni Rimola, Victor Vargas, Francesc Marco, M Almela, Montserrat Forne, Maria Luisa Miranda, Josep Llach, Joan M SalmeronAbstract:Eighty cirrhotic patients who had recovered from an episode of spontaneous bacterial peritonitis were included in a multicenter, double-blind trial aimed at comparing long-term Norfloxacin administration (400 mg/day; 40 patients) vs. placebo (40 patients) in the prevention of spontaneous bacterial peritonitis recurrence. At entry, both groups were similar with respect to clinical and laboratory data, ascitic fluid protein and polymorphonuclear concentrations, number of previous episodes of spontaneous bacterial peritonitis and causative organisms of the index spontaneous bacterial peritonitis. Norfloxacin administration produced a selective intestinal decontamination (elimination of aerobic gram-negative bacilli from the fecal flora without significant changes in other microorganisms) throughout the study in six patients in whom the effect of Norfloxacin on the fecal flora was periodically assessed. Fourteen patients from the placebo group (35%) and five from the Norfloxacin group (12%) developed spontaneous bacterial peritonitis recurrence during follow-up (χ2 = 5.97; p = 0.014) (mean follow-up period = 6.4 ± 0.6 mo; range = 1 to 19 mo). Ten of the 14 spontaneous bacterial peritonitis recurrences in the placebo group and only one of the five spontaneous bacterial peritonitis recurrences in the Norfloxacin group were caused by aerobic gramnegative bacilli (χ2 = 8.87; p = 0.0029). The overall probability of spontaneous bacterial peritonitis recurrence at 1 yr of follow-up was 20% in the Norfloxacin group and 68% in the placebo group (p = 0.0063) and the probability of spontaneous bacterial peritonitis recurrence caused by aerobic gram-negative bacilli at 1 yr of follow-up was 3% and 60%, respectively (p = 0.0013). Only one patient treated with Norfloxacin experienced side effects related to treatment (oral and esophageal candidiasis). These results indicate that long-term selective intestinal decontamination with Norfloxacin is an effective and safe measure to prevent spontaneous bacterial peritonitis recurrence caused by aerobic gram-negative bacilli in cirrhosis. (HEPATOLOGY 1990;12:716–724).
