Incidence of spontaneous bacterial peritonitis among asymptomatic cirrhosis patients undergoing outpatient paracentesis: a systematic review and meta-analysis

Alotaibi, Ammar; Almaghrabi, Majed; Ahmed, Osman; Rodrigues, D.; Iansavichene, Alla; Puka, Klajdi; Gandhi, R.K.; Sey, Michael; Patel, Keyur; Brahmania, Mayur

doi:10.1097/meg.0000000000002279

Cited by 10 publications

(13 citation statements)

References 38 publications

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“…Romney et al [6] noted a prevalence of nearly 0.7% in asymptomatic outpatients. A metaanalysis of 4000 paracenteses in 1532 patients reported a prevalence of 2% among patients with asymptomatic decompensated cirrhosis undergoing routine therapeutic paracentesis [7] (Figure 1).…”

Section: Prevalence Of Sbp In Routine Therapeutic Paracentesis Is Lowmentioning

confidence: 99%

CON: Ascitic fluid cell count should not be routinely sent with every therapeutic paracentesis to assess for spontaneous bacterial peritonitis

Mohy-ud-din,

Noll,

Jonassaint

2023

Clinical Liver Disease

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Section: Prevalence Of Sbp In Routine Therapeutic Paracentesis Is Lowmentioning

confidence: 99%

CON: Ascitic fluid cell count should not be routinely sent with every therapeutic paracentesis to assess for spontaneous bacterial peritonitis

Mohy-ud-din,

Noll,

Jonassaint

2023

Clinical Liver Disease

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“…The prevalence of antibiotic-resistant microorganisms in SBP was 11.77% (95%CI 7.63%-17.73%), with methicillin-resistant Staphylococcus aureus (6.23%), broad-spectrum β-lactamase-producing microorganisms (6.19%) and vancomycin-resistant enterococci (1.91%) being predominant. The incidence of SBP in outpatient paracentesis among patients with asymptomatic cirrhosis was estimated at 2% (95%CI 1%-3%) in a recent meta-analysis that included 16 studies with 1532 patients[ 70 ]. The global pooled mortality rate for SBP was 30.61% (23.30%-39.06%), with in-hospital, 30-d and 90-d mortality rates of 23.38%, 25.64% and 37.64%, respectively[ 69 ].…”

Section: Epidemiology Of Major Complicationsmentioning

confidence: 99%

Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

Liu¹,

Chen²

2022

World J Gastroenterol

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Cirrhosis causes a heavy global burden. In this review, we summarized up-to-date epidemiological features of cirrhosis and its complications. Recent epidemiological studies reported an increase in the prevalence of cirrhosis in 2017 compared to in 1990 in both men and women, with 5.2 million cases of cirrhosis and chronic liver disease occurring in 2017. Cirrhosis caused 1.48 million deaths in 2019, an increase of 8.1% compared to 2017. Disability-adjusted life-years due to cirrhosis ranked 16th among all diseases and 7th in people aged 50-74 years in 2019. The global burden of hepatitis B virus and hepatitis C virus-associated cirrhosis is decreasing, while the burden of cirrhosis due to alcohol and nonalcoholic fatty liver disease (NAFLD) is increasing rapidly. We described the current epidemiology of the major complications of cirrhosis, including ascites, variceal bleeding, hepatic encephalopathy, renal disorders, and infections. We also summarized the epidemiology of hepatocellular carcinoma in patients with cirrhosis. In the future, NAFLD-related cirrhosis will likely become more common due to the prevalence of metabolic diseases such as obesity and diabetes, and the prevalence of alcohol-induced cirrhosis is increasing. This altered epidemiology should be clinically noted, and relevant interventions should be undertaken.

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“…SBP is a common bacterial complication of ascites in the absence of any intra-abdominally surgically treatable source of infection, with a reported prevalence varying between 1.5%-3.5% in the outpatient setting and 10% in the hospitalized patients. [3][4][5][6] In SBP, peritoneal infection results in an inflammatory reaction, and the diagnosis of SBP is made when the ascitic fluid neutrophil count exceeds 250/mm³. Pathogens are identified in circa 60% of cases, comprising mainly of Gram-negative aerobic bacteria (Enterobacteriaceae and non-enterococcal Streptococcus spp.…”

Section: Introductionmentioning

confidence: 99%

Bacterascites confers poor patient prognosis beyond MELD prediction

King

Halliday

Mantovani

et al. 2023

Liver Transplantation

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Spontaneous bacterial peritonitis (SBP) is a well-recognized clinical entity with a poor prognosis. In comparison, the prevalence, microbiological flora, and prognostic significance of bacterascites (BA) (the presence of organism on culture but ascitic PMN <250 cells/mm³) is largely unknown. We, therefore, assessed the prognosis and predictors of outcome in patients with BA in comparison with those with SBP. Ascitic fluid cultures from consecutive patients with cirrhosis from 2008 to 2018 were reviewed retrospectively, and patients with SBP and BA were identified. Baseline demographic, laboratory, and microbiological data were collated and analyzed as prognostic indicators, and clinical outcomes were recorded. Patients were censored at the time of LT, death, or last follow-up. For this study 176 and 213 cases of SBP and BA, respectively, were identified and included. Patients with SBP had significantly higher Model for End-Stage Liver Disease (MELD) (p=<0.01), peripheral blood WCC (p < 0.01), and higher rates of Enterobacteriaceae (p < 0.01) and multi-drug resistant pathogens (p < 0.01). Survival at 1 and 3 months was lower in patients with SBP (p < 0.01) when compared with BA but at 6 months and beyond, no significant difference remained. After the exclusion of deaths within 30 days of presentation, survival between SBP and BA was equivocal at all time points. Mortality was substantially higher across all MELD groupings for both SBP and BA when compared with the predicted mortality calculated by the MELD score alone. BA has a negative impact on patient survival above that predicted by the MELD score. It has similar impact to SBP on patient survival beyond 1 month suggesting it should be seen as a poor prognostic marker and prompt consideration of LT where appropriate. Further studies evaluating the role of secondary prophylaxis in this group are required.

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Incidence of spontaneous bacterial peritonitis among asymptomatic cirrhosis patients undergoing outpatient paracentesis: a systematic review and meta-analysis

Abstract: Supplemental Digital Content is available in the text.

Cited by 10 publications

References 38 publications

CON: Ascitic fluid cell count should not be routinely sent with every therapeutic paracentesis to assess for spontaneous bacterial peritonitis

CON: Ascitic fluid cell count should not be routinely sent with every therapeutic paracentesis to assess for spontaneous bacterial peritonitis

Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

Bacterascites confers poor patient prognosis beyond MELD prediction

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