Optimization of ascitic fluid culture technique

Runyon, Bruce A.; Canawati, Hanna N.; Akriviadis, Evangelos

doi:10.1016/0016-5085(88)90372-1

Cited by 281 publications

(198 citation statements)

References 13 publications

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“…Other infections were culture-negative fever associated with leukocytosis (56), cellulitis (34), spontaneous bacteremia (28), cholangitis (21), secondary peritonitis (19), purulent bronchitis (16), spontaneous bacterial empyema (9), endocarditis (8), bacterascites in the setting of fever and leukocytosis (5), and gastroenteritis (4).…”

Section: Resultsmentioning

confidence: 99%

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Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis

et al. 2002

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The extensive use of invasive procedures and of long-term norfloxacin prophylaxis in the management of cirrhotic patients may have influenced the epidemiology of bacterial infections in cirrhosis. We conducted a prospective evaluation of all bacterial infections diagnosed in patients with cirrhosis in a Liver Unit between April 1998 and April 2000. A total of 405 patients presented 572 bacterial infections in 507 admissions. Spontaneous bacterial peritonitis was the most frequent infection (138 cases). Gram-positive cocci were responsible for 53% of total bacterial infections in the study, being the main bacteria isolated in nosocomial infections (59%). Patients requiring treatment in an intensive care unit and those submitted to invasive procedures presented a higher rate of infections caused by grampositive cocci (77% vs. 48%, P < .001 and 58% vs. 40%, P < .02, respectively). B acterial infection is one of the most important clinical problems in patients with decompensated cirrhosis. It is present at admission or develops during hospitalization in 20% to 60% of the patients. 1-8 On the other hand, it is a common cause of death. Most studies assessing the etiology and clinical types of bacterial infections in cirrhosis were performed in the 1980s. At that time, the most common infections were urinary tract infections, pneumonia, and spontaneous bacterial peritonitis (SBP); most infections were community acquired; and approximately 70% to 80% of the isolated organisms were gram-negative bacilli (GNB). 1-8 However, during the last decade practice in hepatology has considerably changed and this may have influenced the epidemiology of bacterial infections in liver diseases. Treatment of cirrhotic patients with severe complications in intensive care units has been generalized, particularly with the extension of the liver transplantation programs, and the invasive procedures used in this setting are frequently associated with iatrogenic complications including infections. 9 On the other hand, new invasive treatments have been developed and are extensively used for specific complications of cirrhosis, including variceal ligation, transjugular intrahepatic portosystemic shunt, and arterial embolization or percutaneous ablation of hepatocellular carcinoma. These treatments may be also associated with infections. Finally, long-term selective intestinal decontamination with norfloxacin, which was introduced in 1987, is now widely used for the primary and secondary prophylaxis of SBP and spontaneous bacteremia in cirrhosis. 10,11 Norfloxacin prevents infections caused by GNB but not those caused by gram-positive cocci (GPC). All these features may have changed the type and etiology of acute bacterial infections in cirrhosis. However, there is no study on this topic.Another relevant problem, which has not been adequately evaluated is the clinical relevance of infections caused by quinoloneresistant gram-negative bacilli (QR-GNB) in cirrhosis. It is well known that patients submitted to long-term selective intestinal deconta...

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Section: Resultsmentioning

confidence: 99%

“…15 Ascitic and pleural fluids were inoculated into aerobic and anaerobic blood-culture bottles at the patient's bedside. 16 A positive ascitic or pleural fluid culture, however, was not considered necessary for diagnosis. 17 Secondary peritonitis or parapneumonic effusion were diagnosed according to conventional criteria.…”

Section: Methodsmentioning

confidence: 99%

Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis

et al. 2002

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“…21 Multiple prospective trials show that bacterial growth occurs in only about 50% of instances when ascitic fluid with a polymorphonuclear (PMN) count H 250 cells/mm 3 (0.25 ϫ 10 9 /L) is cultured by ''conventional'' methods as compared with approximately 80% if the fluid is inoculated into blood culture bottles at the bedside. 22 …”

Section: Discussionmentioning

confidence: 99%

Management of adult patients with ascites caused by cirrhosis

Runyon¹

1998

Hepatology

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299

131

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Ascites is the most common of the major complications of cirrhosis. The development of ascites is an important landmark in the natural history of cirrhosis and has been proposed as an indication for liver transplantation. The initial evaluation of a patient with ascites should include a history, physical evaluation, and abdominal paracentesis with ascitic fluid analysis. Treatment should consist of abstinence from alcohol, sodium restricted diet, and diuretics. This regimen is effective in Ϸ90% of patients. The treatment options for the diuretic-resistant patients include serial therapeutic paracenteses, liver transplantation, and peritoneovenous shunting. (HEPATOLOGY 1998;27;264-272.) PREAMBLE These guidelines provide a data-supported approach to the care of patients with ascites. They are based on the following: 1) a formal review and analysis of the published world literature (1,045 papers) on ascites (Medline Search from 1966-1996, search terms included ascites, diet therapy, drug therapy, radiotherapy, surgery, and therapy); 2) the American College of Physician' s Manual for Assessing Health Practices and Designing Practice Guidelines 1 ; and 3) several published and draft guidelines, including the American Association for the Study of Liver Diseases' Policy Statement on Development and Use of Practice Guidelines and American Gastroenterological Association' s Policy Statement on Guidelines 2 ; and 4) 15 years of experience on the part of the author in the clinical and laboratory investigations of and care for patients with this problem.These guidelines, intended for use by physicians, suggest preferable approaches to the diagnostic, therapeutic, and preventative aspects of care. These guidelines are intended to be flexible, in contrast with ''standards of care,'' which are inflexible policies to be followed in almost every case. 1 Furthermore, these guidelines were developed for the care of adult patients with clinically detectable ascites. Although the general approach may be applicable to children, the pediatric data base is much smaller and there may be unanticipated differences between adults and children. Patients with ascites that is detected by imaging modalities alone, but not yet clinically evident, are not included because of the lack of published information regarding the natural history of this entity.Specific recommendations are based on relevant published information. In an attempt to standardize recommendations, the Practice Guidelines Committee of the American Association for the Study of Liver Diseases modified the categories of the Infectious Diseases Society of America' s Quality Standards. 3 These categories are reported with each recommendation, using the letters A through E to determine the strength of recommendation and roman numerals I through III to determine quality of evidence upon which recommendations are based, as follows: A, survival benefit; B, improved diagnosis; C, improvement in quality of life; D, relevant pathophysiologic parameters improved; E, impacts cost of heal...

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“…For the bacteriological analysis, 10 mL of the ascitic fluid were inoculated into blood culture bottles at bedside for aerobic and anaerobic bacteria using the Bact-Alert system (Organon-Teknica) (39) .…”

Section: Methodsmentioning

confidence: 99%

Trimethoprim-sulfamethoxazole versus norfloxacin in the prophylaxis of spontaneous bacterial peritonitis in cirrhosis

Álvarez

Mattos

Corrêa

et al. 2005

Arq. Gastroenterol.

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-Background -The prognosis of patients with chronic liver disease and spontaneous bacterial peritonitis is poor, being of great importance its prevention. Aim -To compare the effectiveness of trimethoprim-sulfamethoxazole versus norfloxacin for prevention of spontaneous bacterial peritonitis in patients with cirrhosis and ascites. Patients and Methods -Fifty seven patients with cirrhosis and ascites were evaluated between March 1999 and March 2001. All of them had a previous episode of spontaneous bacterial peritonitis or had ascitic fluid protein concentration ≤1 g/dL and/or serum bilirubin ≥ 2.5 mg/dL. The patients were randomly assigned to receive either 800/160 mg/day of trimethoprim-sulfamethoxazole 5 days a week or 400 mg of norfloxacin daily. The mean time of observation was 163 days for the norfloxacin group and 182 days for the trimethoprim-sulfamethoxazole group. In the statistical analysis, differences were considered significant at the level of 0.05. Results -According to the inclusion criteria, 32 patients (56%) were treated with norfloxacin and 25 (44%) with trimethoprim-sulfamethoxazole. Spontaneous bacterial peritonitis occurred in three patients receiving norfloxacin (9.4%) and in four patients receiving trimethoprim-sulfamethoxazole (16.0%). Extraperitoneal infections occurred in 10 patients receiving norfloxacin (31.3%) and in 6 patients receiving trimethoprim-sulfamethoxazole (24.0%). Death occurred in seven patients (21.9%) who received norfloxacin and in five (20.0%) who received trimethoprim-sulfamethoxazole. Side effects occurred only in the trimethoprim-sulfamethoxazole group. Conclusion -In spite of the reduced number of patients and time of observation, trimethoprim-sulfamethoxazole and norfloxacin were equally effective in spontaneous bacterial peritonitis prophylaxis, suggesting that trimethoprim-sulfamethoxazole is a valid alternative to norfloxacin.

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Optimization of ascitic fluid culture technique

Cited by 281 publications

References 13 publications

Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis

Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis

Management of adult patients with ascites caused by cirrhosis

Trimethoprim-sulfamethoxazole versus norfloxacin in the prophylaxis of spontaneous bacterial peritonitis in cirrhosis

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