Persistent spontaneous fungal peritonitis secondary to<i>Candida albicans</i>in a patient with alcoholic cirrhosis and review of the literature

Majeed, Aneela; Ullah, Waqas; Zahid, Umar; Mohajer, Mayar Al

doi:10.1136/bcr-2016-216979

Cited by 4 publications

(3 citation statements)

References 27 publications

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“…While more is being learned at this time, further research into the topic of fungal infections in cirrhotic patients and surveillance, and potential prophylaxis is needed. 16,17 Multidrug-resistant bacteria were isolated in over 41% of infections in our study. This correlates with the increasing rates of MDR infections being isolated in general and a change in the epidemiology of infections being isolated in cirrhotic patients.…”

Section: Discussionmentioning

confidence: 61%

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Bacterial Infections in Cirrhotic Patients in a Tertiary Care Hospital

Lingiah

Pyrsopoulos

2020

Journal of Clinical and Translational Hepatology

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Background and Aims Patients with cirrhosis are immunocompromised and at higher risk of developing infections compared to the general population. The aim of this study was to assess the incidence of infections in cirrhotic patients in a large academic liver center and investigate potential associations between infections, bacteria isolated, therapeutic regimens used, and mortality. Methods This was a retrospective chart review study, including 192 patients. All patients had a diagnosis of cirrhosis and were admitted to University Hospital. Information collected included demographics, etiology of cirrhosis, identification of bacteria from cultures, multidrug-resistant (MDR) status, antibiotics administered, intensive care unit (ICU) admission, and patient mortality. Results Infections were present in 105 (54.6%) patients, and 60 (31.2%) patients had multiple infections during a hospitalization(s) for infections. A total of 201 infections were identified. Urinary tract infections (UTIs) were the most common infection (37.8%), followed by bacteremia (20.4%), pneumonia (12.9%), spontaneous bacterial peritonitis (SBP) (11.9%), abscess/cellulitis (6.0%), infectious diarrhea (6.0%), and other (5.0%). Escherichia coli was the most common bacteria isolated (13.4%), both among sensitive and MDR infections. MDR bacteria were the cause for 41.3% of all infections isolated. Fungi accounted for 9.5% of infections. 21.9% of patients had decompensation from their infection(s) that required ICU care, and 14.6% of patients died during hospitalization or soon after discharge. Conclusions The incidence of infections in cirrhotic patients is much higher than in their non-cirrhotic counterparts (54.6%), even higher than prior studies suggest. As many of these infections are caused by MDR bacteria and fungal organisms, stronger empiric antibiotics and antifungals should be considered when initially treating this immunocompromised population. However, once organism sensitivities are discovered, narrowing of antibiotic regimens must occur to maintain good antibiotic stewardship.

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Section: Discussionmentioning

confidence: 61%

“…While more is being learned at this time, further research into the topic of fungal infections in cirrhotic patients and surveillance, and potential prophylaxis is needed. 16 , 17 …”

Section: Discussionmentioning

confidence: 99%

Bacterial Infections in Cirrhotic Patients in a Tertiary Care Hospital

Lingiah

Pyrsopoulos

2020

Journal of Clinical and Translational Hepatology

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“…The early diagnosis of such cases is challenging, partially because the extended time required for fungal growth in a conventional microbial culture slows the diagnostic process [19]. Moreover, the usefulness of modalities, such as polymerase chain reaction or assays for the fungal biomarker 1,3-beta-d-glucan in the ascitic fluid for the diagnosis of SFP or fungiascites, has not been well established [10,19], although a previous report of a case of SFP described elevated levels of 1,3-beta-d-glucan in the ascitic fluid [20].…”

Section: Discussionmentioning

confidence: 99%

Retrospective Comparative Study of Spontaneous Peritonitis Associated with Fungal and Bacterial Infection in Patients with Liver Cirrhosis

Shizuma¹

2018

J Liver

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Objective: Although patients with liver cirrhosis (LC) have a high risk of developing bacterial and fungal infections, few studies have evaluated spontaneous fungal peritonitis (SFP) or fungiascites in this population. Accordingly, we conducted a retrospective comparative study of spontaneous peritonitis associated with fungal (SFP and fungiascites) or bacterial culture-positive ascites [spontaneous bacterial peritonitis (SBP) and bacterascites] in patients with LC.Methods: This study enrolled 73 patients with LC and ascitic culture-positive spontaneous peritonitis, including four, three, 35, and 31 patients with SFP, fungiascites, culture-positive SBP, and bacterascites, respectively. We compared the laboratory findings, Child-Pugh scores, and 1-month mortality rates between patients with fungal disease, i.e., spontaneous peritonitis associated with fungal culture-positive ascites (SFP and fungiascites), and those with bacterial disease, i.e., spontaneous peritonitis associated with bacterial culture-positive ascites (culturepositive SBP and bacterascites). Results:We observed no significant differences in the severity of underlying liver dysfunction and renal impairment between patients with fungal and bacterial disease. However, the 1-month mortality rate was significantly higher in patients with fungal disease than in those with bacterial disease (71.4%, 5/7 vs. 25.8%, 17/66; p= 0.038). Conclusion:In our retrospective study population, spontaneous peritonitis caused by fungi (SFP and fungiascites) was associated with a significantly higher short-term mortality rate compared with that of spontaneous peritonitis caused by bacteria (culture-positive SBP and bacterascites).Further studies are required to investigate the underlying mechanisms and determine the effects of antifungal therapy on mortality.

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