Leitlinienmethodenreport zur S3-Leitlinie „Aszites, spontan bakterielle Peritonitis, hepatorenales Syndrom”

Gerbes, AL; Sauerbruch, T.; Dathe, Katarina

doi:10.1055/s-0031-1273404

Cited by 8 publications

(4 citation statements)

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“…SBP was diagnosed in patients with ≥ 500 nucleus containing cells/mm 3 ascites fluid. [12–14]. SBP that occurred within the first 48 hours of hospitalization was classified as a community-acquired SBP (caSBP).…”

Section: Methodsmentioning

confidence: 99%

“…Diagnosis of liver cirrhosis was made on the basis of either ultrasound, FibroScan (≥ 14.5 kPa), typical biochemical results (i.e. AST/ALT ratio >1, bilirubin >1.5 x ULN, platelets < 100 (10 3 /μl), Albumin < 35 g/L) and/ or liver biopsy (F4 in Metavir or F5-6 in ISHAK) or (in the majority of cases) a combination of the above [14,16]. ACLF was diagnosed in concordance with the current recommendations of the European Association for the Study of the Liver (EASL) at baseline.…”

Section: Methodsmentioning

confidence: 99%

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Sustained impact of nosocomial-acquired spontaneous bacterial peritonitis in different stages of decompensated liver cirrhosis

et al. 2019

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Background & aims Bacterial infections, in particular a spontaneous bacterial peritonitis (SBP), are a major threat in patients with liver cirrhosis. Recently, it has been shown that the impact on mortality might be underestimated by established risk-scores. Onset of infection was suggested to define a distinct stage of cirrhosis. However, it remains unclear whether all stages of decompensated cirrhosis are equally affected. Moreover, if there is such a distinct stage, it must be determined whether it is reversible after the infection has resolved. In this study we aimed to further analyze the impact of a current as well as a resolved SBP in different stages of decompensated liver cirrhosis. Methods A number of 579 patients with liver cirrhosis and ascites were included. MELD-score was used to determine the stage of liver disease. Low (<15), intermediate (15–25) and high (>25) MELD-groups were compared. Patients were followed up for 90 days. Primary endpoint was overall mortality. Statistical analyses were performed using the log-rank test, Cox regression and competing risk analysis. Results Mortality was significantly higher in patients with nosocomial-acquired SBP (nSBP) compared to patients without SBP (p<0.001;HR = 2.05). However, the most prominent difference in mortality was documented in the intermediate MELD-group (nSBP: p = 0.02;HR = 2.10). Importantly, mortality in nSBP patients remained increased even after the initial nSBP episode had resolved (p<0.01;HR = 1.90). Again, this was only significant in those with intermediate MELD-scores (p = 0.02;HR = 2.28). While a current as well as a resolved nSBP were significantly linked to a higher mortality, neither of them did increase the likelihood for liver transplantation. Conclusions Development of nSBP is independently associated with increased mortality supporting the concept of a distinct status of cirrhosis. Importantly, the prognosis remains unfavorable even after resolution of nSBP. This could be particularly relevant for patients with intermediate MELD-scores, who have limited chances for a donor liver.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Sustained impact of nosocomial-acquired spontaneous bacterial peritonitis in different stages of decompensated liver cirrhosis

et al. 2019

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“…Laboratory values were documented at the time of the first paracentesis and additionally at the time of diagnosis of the first SBP episode. SBP was diagnosed in patients with ≥500 nucleus containing cells/mm³ ascites fluid in concordance with the German national guideline . Patients with documented PPI intake within 7 days prior to baseline were defined as PPI users.…”

Section: Methodsmentioning

confidence: 99%

Dose‐dependent impact of proton pump inhibitors on the clinical course of spontaneous bacterial peritonitis

Tergast

Wranke

Laser

et al. 2018

Liver International

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“…The observation period included the complete hospital stay until discharge, transfer to another hospital or nursing home, liver transplantation, or death. Infections were diagnosed by the attending physician or in case of uncertainty by infectiologists (BM, MC, JR, CHZS) based on clinical symptoms and the following laboratory results: SBP: ≥ 500 nuclei containing cells/µl ascites fluid [ 20 ] BSI: positive blood cultures UTI: leukocyturia and/or positive urine cultures with significant germination number (≥ 10 5 CFU/ml urine). …”

Section: Methodsmentioning

confidence: 99%

Antimicrobial resistance in patients with decompensated liver cirrhosis and bacterial infections in a tertiary center in Northern Germany

et al. 2021

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Background and aims Bacterial infections are common in patients with decompensated liver cirrhosis and a leading cause of death. Reliable data on antibiotic resistance are required to initiate effective empiric therapy. We here aim to assess the antimicrobial resistance profile of bacteria among patients with liver cirrhosis and infection. Methods Overall, 666 cirrhotic patients admitted to Hannover Medical School between January 2012 and April 2018 with ascites were assessed for bacterial infection. In case of infection, bacteria cultured from microbiological specimens of ascites, blood or urine were identified and analyzed for resistances against common antibiotic agents. Furthermore, analyses compared two periods of time and community-acquired vs. nosocomial infections. Results In 281 patients with infection, microbiological sampling was performed and culture-positive results were obtained in 56.9%. Multidrug-resistant (MDR)-bacteria were found in 54 patients (19.2%). Gram-positive organisms were more common (n = 141/261, 54.0%) and detected in 116/192 culture-positive infections (60.4%). Comparing infections before and after 2015, a numerical decline for MDR-bacteria (23.8% vs. 15.6%, p = 0.08) was observed with a significant decline in meropenem resistance (34.9% vs. 19.5%, p = 0.03). MDR-bacteria were more frequent in the case of nosocomial infections. Of note, in ascites the majority of the tested bacteria were resistant against ceftriaxone (73.8%) whereas significantly less were resistant against meropenem (27.0%) and vancomycin (25.9%). Conclusions In our tertiary center, distinct ratios of gram-positive infection with overall low ratios of MDR-bacteria were found. Adequate gram-positive coverage in the empiric therapy should be considered. Carbapenem treatment may be omitted even in nosocomial infection. In contrast, 3rd generation cephalosporins cannot be recommended even in community-acquired infection in our cirrhotic population.

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Leitlinienmethodenreport zur S3-Leitlinie „Aszites, spontan bakterielle Peritonitis, hepatorenales Syndrom”

Cited by 8 publications

References 0 publications

Sustained impact of nosocomial-acquired spontaneous bacterial peritonitis in different stages of decompensated liver cirrhosis

Sustained impact of nosocomial-acquired spontaneous bacterial peritonitis in different stages of decompensated liver cirrhosis

Dose‐dependent impact of proton pump inhibitors on the clinical course of spontaneous bacterial peritonitis

Antimicrobial resistance in patients with decompensated liver cirrhosis and bacterial infections in a tertiary center in Northern Germany

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