Association between acid suppressive therapy and spontaneous bacterial peritonitis in cirrhotic patients with ascites

Choi, Eun Jung; Lee, Heon Ju; Kim, Kyeong Ok; Lee, Si Hyung; Eun, Jong Ryul; Jang, Byung Ik; Kim, Tae Nyeun

doi:10.3109/00365521.2011.551891

Cited by 57 publications

(67 citation statements)

References 20 publications

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“…Twelve studies were published in journals (Campbell et al, 2008;Bajaj et al, 2009;Choi et al, 2011;Goel et al, 2012;van Vlerken et al, 2012;de Vos et al, 2013;Kwon et al, 2014;Merli et al, 2014;Min et al, 2014;Miura et al, 2014;O'Leary et al, 2014;Ratelle et al, 2014) and 5 studies were reported as conference abstracts (Northup et al, 2008;Bulsiewicz et al, 2009;Aditi et al, 2012;Terg et al, 2012;Mandorfer et al, 2014). We included 8 retrospective cohort studies, 6 case-control studies, and 3 prospective cohort studies.…”

Section: Resultsmentioning

confidence: 99%

“…We could not perform a stratified analysis of duration because of inconsistent definitions. Notably, Choi et al (2011) compared patients who used PPIs for the median duration of time to PPI non-users, deducing that longer duration of PPI use may be associated with an increased risk of SBP. Goel et al (2012) found that patients who had taken PPIs 8 to 90 days before hospitalization for cirrhosis were 79% less likely to develop SBP than those who had taken PPIs within 7 days.…”

Section: Ppi Use and Overall Risk Of Infectionmentioning

confidence: 99%

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Proton pump inhibitor use and risk of spontaneous bacterial peritonitis in cirrhotic patients: a systematic review and meta-analysis

et al. 2015

Genet. Mol. Res.

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ABSTRACT. We used a meta-analysis approach to investigate the association between proton pump inhibitor (PPI) use and risk of spontaneous bacterial peritonitis (SBP) in cirrhotic patients. We searched Ovid Medline, Embase, and the Cochrane Library to identify eligible studies. We included studies that compared cirrhotic patients who did or did not use PPIs. The primary outcome was SBP, and the secondary outcome was overall bacterial infection. Results were pooled using random-effect models. This process led to identification of 12 journal articles and 5 conference abstracts. The pooled data showed that PPI use in patients with cirrhosis and ascites was significantly associated with an increased risk of SBP [odds ratio (OR) = 2.17; 95% confidence interval (CI) = 1.46-3.23; P < 0.05; I 2 = 85.6%] and overall risk of bacterial infection (OR = 1.98; 95%CI = 1.36-2.87; P < 0.05; I 2 = 0). Subgroup analysis revealed that journal articles and studies reporting adjusted effect estimates demonstrated that PPI users had a significantly increased risk of SBP (OR = 2.13; 95%CI = 1.61-2.82; P < 0.05; I 2 = 29.4%; and OR = 1.98; 95%CI = 1.42-2.77; P < 0.05; I 2 = 67%, respectively). In conclusion, PPI use increased the risk of SBP and overall bacterial infection in patients with cirrhosis and ascites. PPIs should be administered after careful assessment of the indications in cirrhotic patients. Future well-designed prospective studies are warranted to clarify the dose relationships and to compare infection risks associated with different classes of PPIs.

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Section: Resultsmentioning

confidence: 99%

Section: Ppi Use and Overall Risk Of Infectionmentioning

confidence: 99%

Proton pump inhibitor use and risk of spontaneous bacterial peritonitis in cirrhotic patients: a systematic review and meta-analysis

et al. 2015

Genet. Mol. Res.

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“…The above study also revealed that 47% of cirrhotic patients receiving PPI had no documented indication for PPI treatment. A recent study on risk factors for bacterial infections among cirrhotics has shown that use of PPI (OR = 3.443, 95% CI 1.164 -10.188; p = 0.025) was a risk factor for SBP [53].…”

Section: Discussionmentioning

confidence: 99%

Infections in Cirrhotics: Types, Microbiological Spectrum and Risk Factors—5-Year Cohort Study

Naqvi¹,

Mahmood²,

Talib³

et al. 2014

OJGas

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Cirrhosis is an immunocompromised state that leads to various infections, with an estimated 30% mortality. Pakistan already has a high morbidity and mortality related to complications of cirrhosis. Where the data on infection among cirrhotics is scanty, this study aimed to determine the frequency, microbiological spectrum and various risk factors of infections in cirrhosis of liver. This is a prospective cohort study conducted at a tertiary care hospital. The microbiological spectrum and frequency of infections was determined in cirrhotics.

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“…Several studies, including a meta-analysis [93] of four studies involving a total of 772 patients [94][95][96][97][98] , found significant association between PPI and the development of SBP in patients with cirrhosis (odds ratio 2.77, 95%CI: 1.82-4.23). However, a recent study suggests that even though PPIs may be a contributing factor, the predominant factor determining infection risk is the stage of the liver disease [99] .…”

Section: Secondary Prophylaxis In Patients With Prior Sbpmentioning

confidence: 99%

Diagnosis and management of bacterial infections in decompensated cirrhosis

Pleguezuelo

Benítez²,

Jurado³

et al. 2013

WJH

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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.

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Association between acid suppressive therapy and spontaneous bacterial peritonitis in cirrhotic patients with ascites

Abstract: PPI use, as well as Child-Pugh class C and high MELD scores, was an independent risk factor for the development of SBP in cirrhotic patients with ascites. Further prospective studies are warranted to clarify this issue.

Cited by 57 publications

References 20 publications

Proton pump inhibitor use and risk of spontaneous bacterial peritonitis in cirrhotic patients: a systematic review and meta-analysis

Proton pump inhibitor use and risk of spontaneous bacterial peritonitis in cirrhotic patients: a systematic review and meta-analysis

Infections in Cirrhotics: Types, Microbiological Spectrum and Risk Factors—5-Year Cohort Study

Diagnosis and management of bacterial infections in decompensated cirrhosis

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