Risk factors for spontaneous bacterial peritonitis in cirrhotic patients with ascites

Andreu, Montserrat; Solá, Ricard; Sitges‐Serra, Antonio; Alia, C.; Gallén, Manuel; Vila, Marta; Coll, Susana; Oliver, María

doi:10.1016/0016-5085(93)90284-j

Cited by 251 publications

(150 citation statements)

References 15 publications

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“…Consequently, hyperbilirubinemia was chosen to be one of the criteria of inclusion. The value of using total bilirubin levels as an independent predictive factor for the development of SBP has already been demonstrated by ANDREU et al (2) . In the present study, it should be noticed that bilirubin was the least frequent single indication for prophylaxis, accounting for 8.8% of indications in the NO group and 16% in the SMZ/TMP group.…”

Section: Discussionmentioning

confidence: 84%

“…However, the most significant infection affecting the cirrhotic patient is spontaneous bacterial peritonitis (SBP). Its prevalence in cirrhotics with ascites at hospital admission ranges from 10% to 27% in the literature (1,2,14) . In our community, SBP prevalence was 11% (8) .…”

Section: Introductionmentioning

confidence: 99%

“…Despite the favorable results in studies evaluating this form of prophylaxis (17,32,42) , the lack of an unequivocal benefit in survival, the inconsistency of the groups studied, and the emergence of resistant bacteria have rendered the indication of primary prophylaxis of SBP disputable. The presence of hyperbilirubinemia, indicating liver dysfunction, could be another element suggesting the importance of this kind of prophylaxis (2) . Indeed, the meeting of the Ascites International Club for defining guidelines for SBP (34) did not reach a consensus about the recommendation of the use of antibiotics in primary prophylaxis.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…Less than half of those who develop spontaneous bacterial peritonitis can be expected to survive a year, whereas the median survival among patients with hepatorenal syndrome is less than 2 weeks. 132,133 Prognostic tools in FHF. The prognosis of individual patients with FHF varies widely.…”

Section: Prognostic Tools In Acute and Chronic Liver Diseasementioning

confidence: 99%

Liver transplantation

Carithers

2000

Liver Transpl

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Liver transplantation has revolutionized the care of patients with end-stage liver disease. Liver transplantation is indicated for acute or chronic liver failure from any cause. Because there are no randomized controlled trials of liver transplantation versus no therapy, the efficacy of this surgery is best assessed by carefully comparing postoperative survival with the known natural history of the disease in question. The best examples of this are in primary biliary cirrhosis and primary sclerosing cholangitis, for which well-validated disease-specific models of natural history are available. There are currently relatively few absolute contraindications to liver transplantation. These include severe cardiopulmonary disease, uncontrolled systemic infection, extrahepatic malignancy, severe psychiatric or neurological disorders, and absence of a viable splanchnic venous inflow system. One of the most frequently encountered contraindications to transplantation is ongoing destructive behavior caused by drug and alcohol addiction. The timing of the surgery can have a profound impact on the mortality and morbidity of patients undergoing liver transplantation. Because of the long waiting lists for donor organs, the need to project far in advance when transplantation might be required has proven to be one of the greatest challenges to those treating patients with end-stage liver disease. Three important questions must be addressed in a patient being considered for liver transplantation: (1) when should the patient be referred for possible transplantation? (2) when should the patient be listed for transplantation? and (3) when is the patient too sick to have a reasonable chance of surviving the perioperative period?

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“…A PBE tem prevalência ao redor de 15% (1,5,18,44) , possuindo taxa de recurrência em 1 ano próxima de 70% (2,42) . Por outro lado, traz ao paciente cirrótico com ascite um empobrecimento no prognóstico tanto a curto, quanto a longo prazo, determinando mortalidade hospitalar, nos dias atuais, em torno de 20% (22,28,43) .…”

Section: Introductionunclassified

Prevalência e prognóstico da peritonite bacteriana espontânea: experiência em pacientes internados em um hospital geral de Porto Alegre, RS, Brasil (1991-2000)

Coral

Mattos

Damo

et al. 2002

Arq. Gastroenterol.

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RESUMO -Racional -A peritonite bacteriana espontânea é complicação freqüente nos pacientes com cirrose e ascite, apresentando taxa de recurrência em 1 ano próxima de 70%. Objetivos -Avaliar a prevalência da peritonite bacteriana espontânea em pacientes com ascite por hepatopatia crônica e o impacto da sua presença na sobrevida dos mesmos. INTRODUÇÃOEstudos demonstram que 30% a 50% dos cirróticos apresentam infecções bacterianas na admissão hospitalar ou a desenvolvem durante a mesma (5,40) . Estas são responsáveis por até 25% das mortes nesta população de pacientes (5,28) .Dentre as infecções que acometem os pacientes com hepatopatia crônica, a de maior importância é a peritonite bacteriana espontânea (PBE) (5) .Entende-se por PBE a infecção do fluido de ascite sem haver um foco intra-abdominal aparente causal da infecção (15) .A PBE tem prevalência ao redor de 15% (1,5,18,44) , possuindo taxa de recurrência em 1 ano próxima de 70% (2,42) . Por outro lado, traz ao paciente cirrótico com ascite um empobrecimento no prognóstico tanto a curto, quanto a longo prazo, determinando mortalidade hospitalar, nos dias atuais, em torno de 20% (22,28,43) .Diante da escassez de estudos (5,14) que analisam a evolução dos pacientes com PBE em nosso País e também as diferenças regionais existentes, entende-se que esta infecção merece ser avaliada em nosso meio, com o intuito de observar seu comportamento nos dias atuais, permitindo assim, a busca de novas estratégias que visem melhorar seu prognóstico. Portanto, teve-se como objetivo principal, avaliar a prevalência da PBE e sua implicação na mortalidade hospitalar de pacientes com ascite secundária à hepatopatia crônica internados em um hospital geral.

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Risk factors for spontaneous bacterial peritonitis in cirrhotic patients with ascites

Cited by 251 publications

References 15 publications

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

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

Liver transplantation

Prevalência e prognóstico da peritonite bacteriana espontânea: experiência em pacientes internados em um hospital geral de Porto Alegre, RS, Brasil (1991-2000)

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