Clinical Features and Prognosis of Spontaneous Bacterial Peritonitis in Korean Patients with Liver Cirrhosis: A Multicenter Retrospective Study

Heo, Jeong; Seo, Yeon Seok; Yim, Hyung Joon; Hahn, Taeho; Park, Sang Hoon; Ahn, Sang Hoon; Park, Jun Yong; Park, Ji Young; Kim, Moon Young; Park, Sung Keun; Cho, Mong; Um, Soon Ho; Han, Kwang Hyub; Kim, Hong Soo; Baik, Soon Koo; Kim, Byung Ik; Cho, Se Hyun

doi:10.5009/gnl.2009.3.3.197

Cited by 58 publications

(52 citation statements)

References 41 publications

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“…[13][14][15][16] Although the mean age among the individuals with SBP was somewhat lower than previously described by other authors (52.8 to 58.4 years), [13][14][15][16] in line with what was found in the present study. 14,16,19 With regard to the etiology of cirrhosis, Heo et al reported…”

Section: Discussionsupporting

confidence: 92%

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Clinical and laboratorial features of spontaneous bacterial peritonitis in southern Brazil

et al. 2014

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CONTEXT AND OBJECTIVE: Spontaneous bacterial peritonitis (SBP) is a severe complication that occurs in 8-27% of hospitalized patients with liver cirrhosis and ascites, with high mortality rates. This study aimed to identify the clinical characteristics associated with SBP. DESIGN AND SETTING: Cross-sectional study, conducted in a public university. The subjects were divided into two groups: SBP and controls. RESULTS:Comparison between individuals with SBP and controls showed that those with SBP had lower mean prothrombin activity time (36.1 ± 16.0% versus 47.1 ± 17.2%; P = 0.044) and lower median serum-ascites albumin gradient (SAAG) (1.2 versus 1.7, P = 0.045). There was a tendency towards higher mean MELD in the SBP group, not significant (22.2 ± 7.6 versus 17.9 ± 6.7; P = 0.067). There was a strong positive correlation between the neutrophil count in ascitic fluid and serum leukocyte count (r = 0.501; P = 0.001) and a negative correlation between the neutrophil count in ascitic fluid with prothrombin activity time (r = -0.385; P = 0.011).CONCLUSION: A few characteristics are associated with the presence of SBP, especially liver dysfunction, SAAG and peripheral leukocytosis. RESULTADOS: Quando se compararam os indivíduos com PBE aos controles, observou-se menor média de tempo de atividade da protrombina (TAP; 36,1 ± 16,0% versus 47,1 ± 17,2%; P = 0,044) e menor mediana de gradiente albumina soro-ascite (GASA; 1,2 versus 1,7; P = 0,045). Houve tendência do grupo com PBE de apresentar maior média de MELD, sem significância estatística (22,2 ± 7,6 versus 17,9 ± 6,7; P = 0,067). Foi observada forte correlação positiva entre neutrófilos do líquido ascítico e contagem sérica de leucócitos (r = 0,501; P = 0,001) e correlação negativa de neutrófilos do líquido ascítico com TAP (r = -0,385; P = 0,011). CONCLUSÃO: Poucas características estão associadas à presença de PBE, em especial a disfunção hepáti-ca, o GASA e a leucocitose periférica. RESUMO

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Section: Discussionsupporting

confidence: 92%

“…Flowchart of potential candidates for inclusion in the study, application of exclusion criteria and individuals included. followed by alcoholic cirrhosis (19.7%) and cirrhosis by HCV (6.4%), 16 and these data are consistent with the high prevalence of HBV in Asia. [20][21][22] In North America, Heidelbaugh et al reported…”

Section: Discussionsupporting

confidence: 77%

Clinical and laboratorial features of spontaneous bacterial peritonitis in southern Brazil

et al. 2014

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“…ESBL-E are predominant in Southern Europe and Asia [7,[13][14][15][16][17][18][19][20][21][22][23][24][25] , meanwhile MRSA and VRE are prevalent in the United States [26] . Carbapenemase-producing K. pneumoniae is a current problem described in some hospitals in Italy [27] .…”

Section: Diversity Of Mr Bacteria Types Across Countriesmentioning

confidence: 99%

“…Regular epidemiology assessment should be carried out in all centers and policies regarding empiric antibiotic treatment in cirrhosis should be updated and tailored according to the specific epidemiological pattern of 918 May 8, 2015|Volume 7|Issue 7| WJH|www.wjgnet.com [13,14,19,20,24] Italy, 8%-20% [17,21] Spain and United States, 6%-9% [7,15,26] France, Denmark and Germany, < 5% [22,23,25] MRSA Italy, 7% [17,21] United States, 5% [26] Spain, 3%-4% [7,15] France, 2% [23] Denmark, Germany, 0% [22,25] Pseudomonas aeruginosa Spain, South Korea, 2%-3% [7,[13][14][15]19,20,24] Germany, 1% [22] Denmark, France, 0% [23,25] VSE Denmark, 12% [25] Germany, 10% [22] France, 5% [23] Spain, 1%-7% [7,15] VRE United States, 9% [26] Spain, France, Denmark, Germany, 0% [7,15,22,23,25] ESBL: Extended-spectrum β-lactamase-producing Enterobacteriaceae (bacteria with chromosomal β-lactamases are also included); MRSA: Methicillinresistant Staphylococcus aureus; VSE: Vancomycin-susceptible Enterococcus; VRE: Vancom...…”

Section: Changing the Empirical Antibiotic Treatment Of Bacterial Infmentioning

confidence: 99%

Multiresistant bacterial infections in liver cirrhosis: Clinical impact and new empirical antibiotic treatment policies

Acevedo

2015

WJH

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Recently, important changes have been reported regarding the epidemiology of bacterial infections in liver cirrhosis. There is an emergence of multiresistant bacteria in many European countries and also worldwide, including the United States and South Korea. The classic empirical antibiotic treatment (third-generation cephalosporins, e.g. , ceftriaxone, cefotaxime or amoxicillin-clavulanic acid) is still effective in infections acquired in the community, but its failure rate in hospital acquired infections and in some health-care associated infections is high enough to ban its use in these settings. The current editorial focuses on the different epidemiology of bacterial infections in cirrhosis across countries and on its therapeutic implications.

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“…Treatment with albumin is particularly effective in patients with serum bilirubin ≥ 4 mg/dL or serum creatinine ≥ 1 mg/dL, while its use in patients without these criteria remains controversial [49] . However, in unselected patients with SBP, even low-dose albumin (10 g/d on day 1 and 3) reduces tumour necrosis factor and interleukin 6 levels in serum and ascites as well as preventing increases in serum nitric oxide induced by SBP [50] .…”

Section: Treatment Of Community-acquired 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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Clinical Features and Prognosis of Spontaneous Bacterial Peritonitis in Korean Patients with Liver Cirrhosis: A Multicenter Retrospective Study

Cited by 58 publications

References 41 publications

Clinical and laboratorial features of spontaneous bacterial peritonitis in southern Brazil

Clinical and laboratorial features of spontaneous bacterial peritonitis in southern Brazil

Multiresistant bacterial infections in liver cirrhosis: Clinical impact and new empirical antibiotic treatment policies

Diagnosis and management of bacterial infections in decompensated cirrhosis

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