Bacterascites: A study of clinical features, microbiological findings, and clinical significance

Abstract

BackgroundKnowledge about bacterascites is limited and management guidelines are based on small patient series. The purpose of this study was to add further insight into the clinical characteristics, microbiological findings, and prognosis of patients diagnosed with bacterascites.MethodsRetrospective analysis of patients with advanced chronic liver disease diagnosed with bacterascites and SBP between January 2003 and August 2016.ResultsIn this study, 123 patients were included with 142 episodes of bacterascites. The median MELD score was 20 and clinical symptoms of infection were present in 78%. Empiric antibiotic treatment was initiated in 68%. In 26 untreated patients undergoing repeated paracentesis, 42% were diagnosed with either ongoing bacterascites or SBP. The presence of signs or symptoms of infection was not an independent predictor for mortality or spontaneous resolution of infection. The 1‐month and 1‐year mortality rates of the 123 patients studied, were 32% and 60%, respectively; these results were in line with data pertaining to the prognosis of SBP.ConclusionsPatients with bacterascites and SBP are highly comparable with respect to severity of liver disease and overall prognosis. If left untreated, bacterascites is likely to persist or to evolve to SBP in a significant proportion of patients. The results of this study support current guidelines regarding the treatment of ascitic fluid infection, but could not confirm the prognostic relevance of symptomatic disease at the time of diagnosis. We suggest that the threshold to initiate antibiotic treatment, in particular in cases with severely advanced liver disease, should be low.

Clinical features and outcomes of bacterascites in cirrhotic patients: A retrospective, multicentre study

“…In our cohort, Gram‐negative bacteria were frequently isolated in culture‐positive SBP patients, which is consistent with the result of a previous report . However, Gram‐positive bacteria were the most frequent type of strain in bacterascites patients, and this result is in line with the findings of recent studies of bacterascites . Patients with cirrhosis are susceptible to various infections that may be caused by bacteria with low virulence.…”

“…Nevertheless, few studies of bacterascites have been reported; therefore, knowledge of the clinical characteristics and management guidelines of bacterascites are limited. Recently, Oey et al reported that 123 patients with bacterascites from single centre were comparable to SBP patients with respect to prognosis …”

How to reduce mortality of bacterascites—That is the question

“…Taken together, the study by Oey et al shows that bacterascites is a special form of ascites infection with a high mortality . Our goal should be to reduce this high mortality.…”

“…Secondly, prognosis of patients with bacterascites was very poor in the study of Oey et al One‐month and one‐year mortality were 36% and 66%, respectively. These mortality rates were comparable to SBP patients from the same centre (34% and 77% respectively).…”

“…Studies on this entity of ascites infection are scarce. Rosalie Oey and her colleagues have added an important study on this topic, which is published in this issue of Liver International . In their retrospective monocentric analysis, they report on 142 episodes of bacterascites in 123 patients occurring over a period of 13 years.…”