Abstract:Background and aim: Spontaneous bacterial peritonitis is a potentially life-threatening infection in patients with liver cirrhosis and ascites. Its prevention is vital to improve prognosis of cirrhotic patients. The main objective of this systematic review was to evaluate what is the most efficacious and safest antibiotic prophylactic strategy.
Methods: Studies were located by searching PubMed and Cochrane Central Register of Controlled Trials in The Cochrane Library until February 2019. Randomized controlled… Show more
“… 38 Other important limitations are the lack of data about antibiotic use in the previous 3 months, including the use of norfloxacin or rifaximin prophylaxis, and the lack of information about hospital admission area (eg, intensive care unit). 39 In addition, due to the limited accuracy of ICD code classification, there is the potential for misclassification of sepsis, liver disease aetiology, cirrhosis and related complications as well as comorbidities. Data were dependent on the quality of coding of hospital admissions, which may vary from site to site (eg, small hospitals in regional areas) and over time.…”
ObjectiveMultiple factors predispose patients with cirrhosis to sepsis and/or bacteraemia and this has a high mortality rate. Within different geographical regions there are marked differences in the prevalence of infection with multidrug-resistant organisms (MDR). This study examined risk factors for and outcomes of sepsis/bacteraemia in public hospital admissions with cirrhosis in the state of Queensland, Australia, over the last decade, along with the bacterial pathogens responsible and their antibiotic susceptibility profiles.DesignA population-based retrospective cohort study of public hospital admissions was conducted from 1 January 2008 to 31 December 2017. Hospital admissions for patients with a diagnosis of cirrhosis were categorised by the presence or absence of sepsis/bacteraemia. Clinical and sociodemographic information including cirrhosis aetiology, complications and comorbidities, and in-hospital mortality were examined using bivariate and multivariate analyses. In patients with bacteraemia, the type and prevalence of bacteria and antibiotic resistance was assessed.ResultsSepsis/bacteraemia was present in 3951 of 103 165 hospital admissions with a diagnosis of cirrhosis. Factors associated with sepsis/bacteraemia included disease aetiology, particularly primary sclerosing cholangitis (adj-OR 15.09, 95% CI 12.24 to 18.60), alcohol (adj-OR 2.90, 95% CI 2.71 to 3.09), Charlson Comorbidity Index ≥3 (adj-OR 3.54, 95% CI 3.19 to 3.93) and diabetes (adj-OR 1.87, 95% CI 1.74 to 2.01). Overall case-fatality rate among admissions with sepsis/bacteraemia was 27.7% (95% CI 26.3% to 29.1%) vs 3.7% (95% CI 3.6% to 3.8%) without sepsis/bacteraemia. In-hospital death was significantly associated with sepsis/bacteraemia (adj-OR 6.50, 95% CI 5.95 to 7.11). The most common organisms identified were Escherichia coli and Staphylococcus aureus, present in 22.9% and 18.1%, respectively, of the 2265 admissions with a positive blood culture. The prevalence of MDR bacteria was low (5.6%)ConclusionMorbidity and mortality related to sepsis/bacteraemia in patients with cirrhosis remains a critical clinical problem.
“… 38 Other important limitations are the lack of data about antibiotic use in the previous 3 months, including the use of norfloxacin or rifaximin prophylaxis, and the lack of information about hospital admission area (eg, intensive care unit). 39 In addition, due to the limited accuracy of ICD code classification, there is the potential for misclassification of sepsis, liver disease aetiology, cirrhosis and related complications as well as comorbidities. Data were dependent on the quality of coding of hospital admissions, which may vary from site to site (eg, small hospitals in regional areas) and over time.…”
ObjectiveMultiple factors predispose patients with cirrhosis to sepsis and/or bacteraemia and this has a high mortality rate. Within different geographical regions there are marked differences in the prevalence of infection with multidrug-resistant organisms (MDR). This study examined risk factors for and outcomes of sepsis/bacteraemia in public hospital admissions with cirrhosis in the state of Queensland, Australia, over the last decade, along with the bacterial pathogens responsible and their antibiotic susceptibility profiles.DesignA population-based retrospective cohort study of public hospital admissions was conducted from 1 January 2008 to 31 December 2017. Hospital admissions for patients with a diagnosis of cirrhosis were categorised by the presence or absence of sepsis/bacteraemia. Clinical and sociodemographic information including cirrhosis aetiology, complications and comorbidities, and in-hospital mortality were examined using bivariate and multivariate analyses. In patients with bacteraemia, the type and prevalence of bacteria and antibiotic resistance was assessed.ResultsSepsis/bacteraemia was present in 3951 of 103 165 hospital admissions with a diagnosis of cirrhosis. Factors associated with sepsis/bacteraemia included disease aetiology, particularly primary sclerosing cholangitis (adj-OR 15.09, 95% CI 12.24 to 18.60), alcohol (adj-OR 2.90, 95% CI 2.71 to 3.09), Charlson Comorbidity Index ≥3 (adj-OR 3.54, 95% CI 3.19 to 3.93) and diabetes (adj-OR 1.87, 95% CI 1.74 to 2.01). Overall case-fatality rate among admissions with sepsis/bacteraemia was 27.7% (95% CI 26.3% to 29.1%) vs 3.7% (95% CI 3.6% to 3.8%) without sepsis/bacteraemia. In-hospital death was significantly associated with sepsis/bacteraemia (adj-OR 6.50, 95% CI 5.95 to 7.11). The most common organisms identified were Escherichia coli and Staphylococcus aureus, present in 22.9% and 18.1%, respectively, of the 2265 admissions with a positive blood culture. The prevalence of MDR bacteria was low (5.6%)ConclusionMorbidity and mortality related to sepsis/bacteraemia in patients with cirrhosis remains a critical clinical problem.
“…RFX was superior to ciprofloxacin, trimethoprim-sulfamethoxazole, norfloxacin and placebo; more over, with RFX there was less mortality and liver transplants. 61 Figure 7 Proportion (%) of patients who developed spontaneous bacterial peritonitis (SBP) during antibiotic prophylaxis for 6 months. Primary prophylaxis = patients without previous episodes of SBP.…”
Section: Rifaximin In the Liver Cirrhosis Evolution And Its Complicat...mentioning
RFX, a rifamycin-based antibacterial agent obtained by the culture of the actinomycete Streptomyces mediterranei, has a broad antibacterial spectrum covering gram- positive, gram-negative, aerobic, and anaerobic bacteria. RFX is an antibiotic that elicits its effect by inhibiting bacterial RNA synthesis. When administered orally, its intestinal absorption is extremely low (<0.4%), restricting antibacterial activity mainly in the intestinal tract, with few systemic side effects. RFX has been recommended by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver guidelines for the treatment of HE. RFX may contribute to restore hepatic function and to decrease the development of liver fibrosis. Its efficacy has been shown in patients with previous hepatic encephalopathy and several complications, such as infections, including spontaneous bacterial peritonitis, ascites and oesophageal variceal bleeding. Thus, RFX has an outstanding role in the therapeutic arsenal in hepatic cirrhosis, under the concept of disease modifier.
“…Já na profilaxia secundária, houve eficácia semelhante com uso de norfloxacina ou sulfametoxazoltrimetoprim. Nesse caso, a rifaximina apresentou maior eficácia do que a norfloxacina, com menos efeitos adversos e menor mortalidade (PIMENTEL et al, 2021).…”
Section: Tratamentounclassified
“…Deve-se levar em consideração que o fator socioeconômico e o uso indevido de antibióticos estão diretamente associados à prevalência de PBE (TAY et al, 2021). Logo, a prevenção a partir do uso de antibióticos é de grande interesse quando indicada (PIMENTEL et al, 2021). Desse modo, considerando a relevância do tema na prática médica e no prognóstico desses pacientes, o estudo possui como objetivo conscientizar os leitores sobre a peritonite bacteriana espontânea e sua profilaxia, bem como orientar e incentivar seu diagnóstico e tratamento precoce em unidade hospitalar.…”
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