Ascitic fluid polymorphonuclear cell count and serum to ascites albumin gradient in the diagnosis of bacterial peritonitis

Albillos, A.; Cuervas-Mons, Valentín; Millán, Isabel; Canton, Tracy; Montes, Jorge; Barrios, C.; Garrido, A; Escartín, P

doi:10.1016/0016-5085(90)91301-l

Cited by 110 publications

(42 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Diagnosis of SBP constitutes an indication to initiate an empirical antibiotic therapy and must not be delayed until the ascites bacteriological culture results are available [7,8] . The best specificity for diagnosis has been reported [19][20][21][22] with a cut-off of 500 PMN/mm 3 . It is unclear whether a positive culture in the absence of elevated ascitic fluid PMN count (bacteriascites), requires antibiotic therapy.…”

Section: Diagnosis Of Spontaneous Bacterial Peritonitismentioning

confidence: 99%

Diagnosis and management of bacterial infections in decompensated cirrhosis

Pleguezuelo

Benítez²,

Jurado³

et al. 2013

WJH

View full text Add to dashboard Cite

Bacterial infections are one of the most frequent complications in cirrhosis and result in high mortality rates. Patients with cirrhosis have altered and impaired immunity, which favours bacterial translocation. Episodes of infections are more frequent in patients with decompensated cirrhosis than those with compensated liver disease. The most common and life-threatening infection in cirrhosis is spontaneous bacterial peritonitis followed by urinary tract infections, pneumonia, endocarditis and skin and soft-tissue infections. Patients with decompensated cirrhosis have increased risk of developing sepsis, multiple organ failure and death. Risk factors associated with the development of infections are severe liver failure, variceal bleeding, low ascitic protein level and prior episodes of spontaneous bacterial peritonitis (SBP). The prognosis of these patients is closely related to a prompt and accurate diagnosis. An appropriate treatment decreases the mortality rates. Preventive strategies are the mainstay of the management of these patients. Empirical antibiotics should be started immediately following the diagnosis of SBP and the first-line antibiotic treatment is third-generation cephalosporins. However, the efficacy of currently recommended empirical antibiotic therapy is very low in nosocomial infections including SBP, compared to community-acquired episodes. This may be associated with the emergence of infections caused by Enterococcus faecium and extended-spectrum β-lactamaseproducing Enterobacteriaceae, which are resistant to the first line antimicrobial agents used for treatment. The emergence of resistant bacteria, underlines the need to restrict the use of prophylactic antibiotics to patients with the greatest risk of infections. Nosocomial infections should be treated with wide spectrum antibiotics. Further studies of early diagnosis, prevention and treatment are needed to improve the outcomes in patients with decompensated cirrhosis.

show abstract

Section: Diagnosis Of Spontaneous Bacterial Peritonitismentioning

confidence: 99%

Diagnosis and management of bacterial infections in decompensated cirrhosis

Pleguezuelo

Benítez²,

Jurado³

et al. 2013

WJH

View full text Add to dashboard Cite

show abstract

“…Clinical and experimental evidence indicates that translocation of bacteria from the intestinal lumen to the bloodstream is directly involved in the pathogenesis of these spontaneous infections. SBP is caused predominantly by enteric organisms, 1 and selective intestinal decontamination lowers the rate of first or recurrent SBP in cirrhotic patients. 2 Studies in carbon tetrachloride (CCl 4 )-induced cirrhotic rats have shown the frequent, simultaneous presence of bacterial translocation (BT) and SBP caused by enteric organisms, 3-5 a higher rate of BT in ascitic than in nonascitic animals, 6 frequent genotype identity between ileal flora and bacteria colonizing the mesenteric lymph nodes (MLN), 7 and a reduction, by selective intestinal decontamination, in the incidence of BT after hemorrhagic shock.…”

mentioning

confidence: 99%

Effect of propranolol on the factors promoting bacterial translocation in cirrhotic rats with ascites

et al. 2000

View full text Add to dashboard Cite

Bacterial translocation appears to be an important mechanism in the pathogenesis of spontaneous infections in cirrhosis. Cirrhotic patients are commonly treated with ␤-adrenoceptor blockers, but the impact of this treatment in the factors promoting bacterial translocation has not been investigated. This study was aimed at investigating in cirrhotic rats with ascites the effect of propranolol on intestinal bacterial load, transit, and permeability of the bowel and on the rate of bacterial translocation. Bacterial translocation to mesenteric lymph nodes and intestinal bacterial overgrowth, permeability (urinary excretion of 99m Tc-diethylenetriaminepentaacetic acid [ 99m Tc-DTPA]), and transit (geometric center ratio of 51 Cr) were assessed in 29 rats with carbon tetrachloride (CCl 4 ) cirrhosis and 20 controls. These variables were then measured in 12 placebo-and in 13 propranolol-treated ascitic cirrhotic rats. Bacterial translocation was present in 48% of the cirrhotic rats and in none of the controls. Cirrhotic rats with intestinal bacterial overgrowth had a significantly higher rate of translocation and slower intestinal transit than those without it. Among the 15 rats with overgrowth and a 99m Tc-DTPA excretion greater than 10%, 15 had translocation and 2 had bacterial peritonitis. Only 1 of the 14 rats with either intestinal overgrowth or a 99m Tc-DTPA excretion greater than 10% presented translocation. Compared with the placebo group, propranolol-treated animals had significantly lower portal pressure, faster intestinal transit, and lower rates of bacterial overgrowth and translocation. In ascitic cirrhotic rats, bacterial translocation results from intestinal overgrowth and severe damage to gut permeability. In this setting, intestinal overgrowth is associated with intestinal hypomotility. Propranolol accelerates the intesti- Cirrhotic patients are prone to bacterial infections, with spontaneous bacterial peritonitis (SBP) being the most characteristic. Clinical and experimental evidence indicates that translocation of bacteria from the intestinal lumen to the bloodstream is directly involved in the pathogenesis of these spontaneous infections. SBP is caused predominantly by enteric organisms, 1 and selective intestinal decontamination lowers the rate of first or recurrent SBP in cirrhotic patients. 2 Studies in carbon tetrachloride (CCl 4 )-induced cirrhotic rats have shown the frequent, simultaneous presence of bacterial translocation (BT) and SBP caused by enteric organisms, 3-5 a higher rate of BT in ascitic than in nonascitic animals, 6 frequent genotype identity between ileal flora and bacteria colonizing the mesenteric lymph nodes (MLN), 7 and a reduction, by selective intestinal decontamination, in the incidence of BT after hemorrhagic shock. 8 The factors that favor BT in cirrhosis are incompletely understood. Proposed mechanisms include disruption of the equilibrium of normal intestinal bacterial flora, increased permeability of the intestinal mucosal barrier, and deficiencies in host immune def...

show abstract

“…All paThis study confirms that SBEM is a frequent complication of cirrhotic patients with hydrothorax; its 13% tients had advanced cirrhosis and most had been hospitalized on previous occasions with clinical signs incidence is similar to the reported SBP incidence in cirrhotic patients with ascites. [1][2][3]13 We believe that of progressive liver dysfunction. Abdominal pain, one of the most common symptoms, was caused by an asso-SBEM is rarely diagnosed, not only because patients with hydrothorax are unusual, but because thoracenteciated SBP in all cases.…”

Section: Treatmentmentioning

confidence: 96%

Spontaneous bacterial empyema in cirrhotic patients: A prospective study

et al. 1996

View full text Add to dashboard Cite

Whereas spontaneous bacterial peritonitis (SBP) isSpontaneous bacterial empyema (SBEM) is an infection of a preexisting hydrothorax in cirrhotic patients a well-known entity with a reported incidence between and has seldom been reported. To determine its inci-15% and 20% in hospitalized cirrhotic patients with dence and primary characteristics, all cirrhotic patients ascites, 1-3 spontaneous bacterial empyema (SBEM)-with pleural effusion underwent thoracentesis at our the infection of a preexisting hydrothorax-has seldom hospital either on admission or when an infection was been reported. 4 Because 5% to 10% of cirrhotic patients suspected. Pleural fluid (PF) study included biochemi-with ascites have an associated hydrothorax, 5,6 SBEM cal analysis, polymorphonuclear (PMN) leukocyte count, could be expected to appear in 1% to 2% of hospitalized and culture by two methods: conventional and modified cirrhotic patients with ascites. Apart from case reports, (inoculation of 10 mL of PF into a blood culture bottle at only two retrospective series including a total of 15 the bedside). SBEM was defined according to previously episodes have been published. 4,7 The aim of this study reported criteria: PF culture positive or PMN count was to investigate incidence, bacteriology, and clinical greater than 500 cells/mL, and exclusion of parapneumonic effusions. Sixteen of the 120 (13%) cirrhotic characteristics of SBEM and to confirm the data obpatients admitted with hydrothorax had 24 episodes of tained in our previous retrospective study. 4 SBEM. In 10 of the 24 episodes (43%), SBEM was not associated with spontaneous bacterial peritonitis (SBP). PATIENTS AND METHODS PF culture was positive by the conventional method inIn a university-based reference hospital, from September 8 episodes (33%) and by the modified method (blood cul-1988 to December 1992, a thoracentesis was performed on ture inoculation) in 18 (75%) (P Å .004, McNemar). The all cirrhotic patients with pleural effusion on admission (or microorganisms identified in PF were Escherichia coli when the effusion was detected for the first time during hosin 8 episodes, Streptococcus species in 4, Enterococcus pitalization) or when an infection was suspected during adspecies in 3, Klebsiella pneumoniae in 2, and Pseudomomission because of fever, abdominal or chest pain, hepatic nas stutzeri in 1. All episodes were treated with antibiotencephalopathy, or shock. If ascites was present, a paracenteics without inserting a chest tube in any case. Mortality sis also was performed at the same time. Pleural fluid (PF) during treatment was 20%. We conclude that SBEM is a study included bacteriologic study, cytology, polymorphonucommon complication of cirrhotic patients with hydroclear (PMN) leukocyte count, and glucose, protein, amylase, thorax. Almost half of the episodes were not associated lactic dehydrogenase, and adenosine deaminase determinawith SBP; thus, thoracentesis should be performed in tions. pH also was performed if an infection was suspected. patients with cirr...

show abstract

Ascitic fluid polymorphonuclear cell count and serum to ascites albumin gradient in the diagnosis of bacterial peritonitis

Cited by 110 publications

References 18 publications

Diagnosis and management of bacterial infections in decompensated cirrhosis

Diagnosis and management of bacterial infections in decompensated cirrhosis

Effect of propranolol on the factors promoting bacterial translocation in cirrhotic rats with ascites

Spontaneous bacterial empyema in cirrhotic patients: A prospective study

Contact Info

Product

Resources

About