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Bauer, Tilman; Follo, Antonio; Navasa, Miguel; Vila, Jordi; Planas, Ramón; Clemente, G.; Vargas, Vı́ctor; Bory, Felipe; Vaquer, P; Rodés, Juan

doi:10.1023/a:1015386901343

Cited by 58 publications

(9 citation statements)

References 24 publications

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“…After recovery from SBP, norfloxacin (400 mg/day) decreases the recurrence rate from 68% to 20%, and decreases recurrence by Gram-negative bacteria from 60% to 3% [ 253 ]. Norfloxacin at 400 mg/day yields a lower tendency of recurrence rate than rufloxacin at 400 mg/week (26% vs. 36%, P =0.16), which was due to a lower rate of recurrence by the Enterobacteriaceae with norfloxacin treatment (0% vs. 22%, P =0.01) [ 254 ]. In a prospective study using trimethoprim-sulfamethoxazole (160-800 mg) and norfloxacin for secondary prevention, the recurrence rate of SBP did not differ between the trimethoprim-sulfamethoxazole group and the norfloxacin group (10.0% vs. 9.1%, P =0.50) [ 255 ].…”

Section: Spontaneous Bacterial Peritonitismentioning

confidence: 99%

KASL clinical practice guidelines for liver cirrhosis: Ascites and related complications

2018

Clin Mol Hepatol

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Section: Spontaneous Bacterial Peritonitismentioning

confidence: 99%

KASL clinical practice guidelines for liver cirrhosis: Ascites and related complications

2018

Clin Mol Hepatol

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“…One randomized, double-blind, placebo-controlled trial of norfloxacin (400 mg/day orally) in patients with a history of SBP found the chance of SBP recurrence fall from 68% to 20% [37]. Another open-label, randomized study compared norfloxacin 400 mg/day to rufloxacin 400 mg/week in the prevention of SBP recurrence [119]. Although the one-year probability of SBP recurrence was not significantly different to control (26% versus 36%, p = 0.16), norfloxacin was effective in the prevention of SBP recurrence due to Enterobacteriaceae (0% vs. 22%, p = 0.01) [119].…”

Section: Prophylaxis Of Sbp 101 Sbp Prophylaxis In High-risk Groupsmentioning

confidence: 99%

“…Another open-label, randomized study compared norfloxacin 400 mg/day to rufloxacin 400 mg/week in the prevention of SBP recurrence [119]. Although the one-year probability of SBP recurrence was not significantly different to control (26% versus 36%, p = 0.16), norfloxacin was effective in the prevention of SBP recurrence due to Enterobacteriaceae (0% vs. 22%, p = 0.01) [119].…”

Section: Prophylaxis Of Sbp 101 Sbp Prophylaxis In High-risk Groupsmentioning

confidence: 99%

Spontaneous Bacterial Peritonitis in Decompensated Liver Cirrhosis—A Literature Review

Huang

Lee

Chang

2022

Livers

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Background: Spontaneous bacterial peritonitis (SBP) is defined as a bacterial infection of the ascitic fluid without a surgically treatable intra-abdominal infection source. SBP is a common, severe complication in cirrhosis patients with ascites, and if left untreated, in-hospital mortality may exceed 90%. However, the incidence of SBP has been lowered to approx. 20% through early diagnosis and antibiotic therapy. Clinical awareness, prompt diagnosis, and immediate treatment are advised when caring for these patients to reduce mortality and morbidity. Aim: To discuss important issues comprising types of SBP, pathogenesis, bacteriology, including the emergence of multidrug-resistant (MDR) microorganisms, prompt diagnosis, risk factors, prognosis, treatment strategies, as well as recurrence prevention through antibiotic prophylaxis until liver transplantation and future trends in treating and preventing SBP in detail. Methods: This article is a literature review and appraisal of guidelines, randomized controlled trials, meta-analyses, and other review articles found on PubMed from between 1977 and 2022. Results: There are three types of SBP. Bacterial translocation from GI tract is the most common source of SBP. Therefore, two thirds of SBP cases were caused by Gram-negative bacilli, of which Escherichia coli is the most frequently isolated pathogen. However, a trend of Gram-positive cocci associated SBP has been demonstrated in recent years, possibly related to more invasive procedures and long-term quinolone prophylaxis. A diagnostic paracentesis should be performed in all patients with cirrhosis and ascites who require emergency room care or hospitalization, who demonstrate or report consistent signs/symptoms in order to confirm evidence of SBP. Distinguishing SBP from secondary bacterial peritonitis is essential because the conditions require different therapeutic strategies. The standard treatment for SBP is prompt broad-spectrum antibiotic administration and should be tailored according to community-acquired SBP, healthcare-associated or nosocomial SBP infections and local resistance profile. Albumin supplementation, especially in patients with renal impairment, is also beneficial. Selective intestinal decontamination is associated with a reduced risk of bacterial infection and mortality in high-risk group. Conclusions: The standard treatment for SBP is prompt broad-spectrum antibiotic administration and should be tailored according to community-acquired SBP, healthcare-associated or nosocomial SBP infections and local resistance profile. Since the one-year overall mortality rates for SBP range from 53.9 to 78%, liver transplantation should be seriously considered for SBP survivors who are good candidates for transplantation. Further development of non-antibiotic strategies based on pathogenic mechanisms are also urgently needed.

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“…Data to sustain secondary prophylaxis for SBP arose from two clinical trials performed in the 1990s and early 2000s. These studies showed that the cumulative incidence of SBP recurrence at one year reached 20%-26% in patients receiving norfloxacin compared to 68% in patients in the placebo group[11,12]. Notably, these randomized controlled trials included fluoroquinolones that were effective in treating Gram-negative bacilli, the predominant etiology of SBP at that time.…”

Section: Introductionmentioning

confidence: 99%

Unresolved issues in the prophylaxis of bacterial infections in cirrhosis patients

Dirchwolf

Marciano

Martínez

et al. 2018

WJH

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Bacterial infections are highly prevalent and a frequent cause of hospitalization and short-term mortality in patients with cirrhosis. Due to their negative impact on survival, antibiotic prophylaxis for bacterial infections in high-risk subgroups of patients with cirrhosis has been the standard of care for decades. Patients with prophylaxis indications include those at risk for a first episode of spontaneous bacterial peritonitis (SBP) due to a low ascitic fluid protein count and impaired liver and kidney function, patients with a prior episode of SBP and those with an episode of gastrointestinal bleeding. Only prophylaxis due to gastrointestinal bleeding has a known and short-time duration. All other indications imply long-lasting exposure to antibiotics - once the threshold requirement for initiating prophylaxis is met - without standardized criteria for re-assessing antibiotic interruption. Despite the fact that the benefit of antibiotic prophylaxis in reducing bacterial infections episodes and mortality has been thoroughly reported, the extended use of antibiotics in patients with cirrhosis has also had negative consequences, including the emergence of multi-drug resistant bacteria. Currently, it is not clear whether restricting the use of broad and fixed antibiotic regimens, tailoring the choice of antibiotics to local bacterial epidemiology or selecting non-antibiotic strategies will be the preferred antibiotic prophylaxis strategy for patients with cirrhosis in the future.

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Cited by 58 publications

References 24 publications

KASL clinical practice guidelines for liver cirrhosis: Ascites and related complications

KASL clinical practice guidelines for liver cirrhosis: Ascites and related complications

Spontaneous Bacterial Peritonitis in Decompensated Liver Cirrhosis—A Literature Review

Unresolved issues in the prophylaxis of bacterial infections in cirrhosis patients

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