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

Abstract

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.

Spontaneous Fungal Peritonitis in Patients with Liver Cirrhosis

“…The reports of serum Cr level are also inconsistent. As in this series, some comparative studies reported no significant differences in serum Cr between SFP and SBP [6,7,10] or between spontaneous peritonitis with a fungus-positive ascitic culture and spontaneous peritonitis with a bacteria-positive ascitic culture [11,12]. However, Elkhateeb et al [9] found that serum Cr was significantly higher in SFP than in SBP (culture-negative neutrocytic ascites).…”

“…Regarding the severity of underlying disease, Gravito-Soares et al [6] reported no significant differences in the Child-Pugh and MELD scores between patients with SFP and SBP. Our previous study [7] also reported no significant differences in the Child-Pugh scores between SFP and culture-positive SBP. Bucsics et al [11] and our previous study [12] reported no significant differences in the Child-Pugh scores between spontaneous peritonitis with a funguspositive ascitic culture and spontaneous peritonitis with a bacteriapositive ascitic culture.…”

“…[11] and Fusarium solani [37]. In SFP cases, 32% to 74% included polymicrobial infections (e.g., bacterial co-colonization) [6,7,10,11,14,30].…”

“…A few studies have compared the serum and ascitic fluid findings in SFP and SBP [6][7][8][9][10] or in spontaneous peritonitis with a funguspositive ascitic culture (SFP and fungiascites) and spontaneous peritonitis with a bacteria-positive ascitic culture (culture-positive SBP and bacterascites) [11,12]. Some comparative studies reported no significant differences in PT or albumin or bilirubin levels between SFP and SBP patients [6,7,9] or between spontaneous peritonitis with a fungus-positive ascitic culture and those with a bacteria-positive ascitic culture [11,12]. The reports of serum Cr level are also inconsistent.…”

“…Although the clinical characteristics and prognosis of SBP have been well documented [5], the clinical characteristics of SFP and fungiascites in patients with LC are less well known. However, some clinical studies of SFP and fungiascites have been reported in recent years, including those that have evaluated and compared SFP and SBP [6][7][8][9][10] or spontaneous peritonitis with a funguspositive ascitic culture (SFP or fungiascites) and spontaneous peritonitis with a bacteria-positive ascitic culture (culture-positive SBP or bacterascites) [11,12]. In the present article, we review and summarize spontaneous peritonitis due to fungal infections (SFP and fungiascites).…”