Spontaneous bacterial peritonitis (SBP): clinical, laboratory and prognostic features. A single center experience

Thanopoulou, Anastasia; Koskinas, John; Hadziyannis, S.

doi:10.1016/s0168-8278(01)81079-5

Cited by 8 publications

(9 citation statements)

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“…When analyzing data for outcomes of SBP versus non-SBP, a higher mortality rate in patients with the SBP was evident, and it was consistent with the other findings [27]. Mortality rates of SBP cases are vary between 20% to 70% [28]. Mortality being generally due to complications such as acute variceal bleeding, development of the hepatorenal syndrome or progressive liver failure.…”

Section: Discussionsupporting

confidence: 81%

Spontaneous Bacterial Peritonitis in the Medical Intensive Care Unit of a University Hospital in Egypt: Frequency, Bacteriological Profile, Risk Factors and Outcomes

Yousef¹,

Amer²,

Zidan³

et al. 2016

int. arab. j antimicrob. agents

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Objective: To assess the frequency of spontaneous bacterial peritonitis (SBP) in the Medical intensive care unit (ICU) of Zagazig University Hospital, identify the causative organisms, their susceptibility to antimicrobials, and to determine risk factors and clinical outcomes. Methods:One hundred and eighty-nine ascitic patients suffered of liver cirrhosis were included in this prospective study. Medical history, physical examination, radiological reports and assessment of disease severity were done. Diagnostic paracentesis was performed. Ascitic fluid was subjected to chemical, hematological and bacteriological investigations. Isolated bacteria and their antibiotic susceptibility pattern were identified using standard methods.Results: Frequency of SBP in ascitic patients due to liver cirrhosis was 56.1%. Classic SBP was diagnosed in 47.2% of cases and the remaining 52.8% were found to be culture negative neutrocytic ascites (CNNA). Comparison of the mean ± standard deviation (SD) of clinical and demographic characteristics for SBP versus non SBP revealed significant association with hepatocellular carcinoma (HCC) and with beta blockers(BB). Comparison between mean ± SD of clinical, biochemical and microbiological characteristics for SBP variants revealed significant association with HCC, total leucocytic count and positive culture. Significant symptoms and signs were observed with fever, hypotension and abdominal pain. E-coli was the most frequently isolated bacteria (56%), followed by Klebsiella pneumoniae 24% and Staphylococcus aureus 20%. Gentamicin was the most effective antibiotic in-vitro against K. pneumonia and E. coli isolates, while all S.

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Section: Discussionsupporting

confidence: 81%

Spontaneous Bacterial Peritonitis in the Medical Intensive Care Unit of a University Hospital in Egypt: Frequency, Bacteriological Profile, Risk Factors and Outcomes

Yousef¹,

Amer²,

Zidan³

et al. 2016

int. arab. j antimicrob. agents

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“…There was no significant difference in PELD score between patients with infected and non-infected ascites. These results are similar to a study done on hospitalized adult patients [ 32 ] and on outpatients with and without SBP [ 33 ].…”

Section: Discussionsupporting

confidence: 91%

Routine analysis of ascitic fluid for evidence of infection in children with chronic liver disease: Is it mandatory?

Ghobrial¹,

Mogahed²,

El‐Karaksy³

2018

PLoS ONE

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Ascitic fluid infection is a major cause of morbidity and mortality in cirrhotic patients, requiring early diagnosis and therapy. We aimed to determine predictors of ascitic fluid infection in children with chronic liver disease. The study included 45 children with chronic liver disease and ascites who underwent 66 paracentesis procedures. Full history taking and clinical examination of all patients were obtained including fever, abdominal pain and tenderness and respiratory distress. Investigations included: complete blood count, C-reactive protein, full liver function tests, ascitic fluid biochemical analysis, cell count and culture. Our results showed that patients’ ages ranged between 3 months to 12 years. Prevalence of ascitic fluid infection was 33.3%. Gram-positive bacteria were identified in six cases, and Gram-negative bacteria in five. Fever and abdominal pain were significantly more associated with infected ascites (p value = 0.004, 0.006). Patients with ascitic fluid infection had statistically significant elevated absolute neutrophilic count and C-reactive protein. Logistic regression analysis showed that fever, abdominal pain, elevated absolute neutrophilic count and positive C-reactive protein are independent predictors of ascitic fluid infection. Fever, elevated absolute neutrophilic count and positive C-reactive protein raise the probability of ascitic fluid infection by 3.88, 9.15 and 4.48 times respectively. The cut-off value for C-reactive protein for ascitic fluid infection was 7.2 with sensitivity 73% and specificity of 71%. In conclusion, prevalence of ascitic fluid infection in pediatric patients with chronic liver disease and ascites was 33.3%. Fever, abdominal pain, positive C-reactive protein and elevated absolute neutrophilic count are strong predictors of ascitic fluid infection. Therefore an empirical course of first-line antibiotics should be immediately started with presence of any of these predictors after performing ascitic fluid tapping for culture and sensitivity. In absence of these infection parameters, routine ascitic fluid analysis could be spared.

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“…The treatment response to SBP with injection cefotaxime was 85% in a study by Navasa et al [25] Our study also showed almost similar response rate. Thanopoulou et al [26] showed that resolution of SBP was achieved in 90% patients with cefotaxime or quinolone. In another study, Franca et al [27] found resolution rate on day 5 of treatment to be 73%.…”

Section: Discussionmentioning

confidence: 99%

A study of bacteriological profile of ascitic fluid in suspected clinical cases of spontaneous bacterial peritonitis at a tertiary care hospital in India

Purohit¹,

Malek²,

Desai³

et al. 2015

Int J Med Sci Public Health

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defined by the presence of ≥250 polymorphonuclear cells (PMN)/mm 3 in ascites in the absence of an intra-abdominal source of infection or malignancy. It is the most common bacterial infection in cirrhosis, accounting for 10%-30% of all reported bacterial infections in the patients admitted to hospital. [1-3] In outpatients without symptoms, the prevalence is low (3.5% [4] or lower [5, 6]), but in the nosocomial setting, the prevalence increases, ranging from 8% to 36%. [7,8] SBP is diagnosed when (a) the ascitic fluid culture grows pathogenic bacteria (almost always pure growth of a single type of organism), (b) the ascitic fluid neutrophils count is ≥250 cells/mm 3 , and (c) there is no evidence of surgically treatable intra-abdominal sources of infection. Depending on the culture and cell count ascitic fluid results, SBP has been classified into two variants [8] : Background: Spontaneous bacterial peritonitis (SBP) is the development of a monomicrobial infection of ascitic fluid in the absence of any contiguous source of infection. It occurs most commonly in conjunction with cirrhosis of the liver and alcoholic liver diseases. Majority of the SBP cases are caused by gram-negative organisms, mostly Escherichia coli. Objective: To isolate the various bacteriological agents from ascitic fluid from clinically suspected cases of SBP and to determine their antibiotic sensitivity pattern. Materials and Methods: In this study, 217 ascitic fluid samples from clinically suspected cases of SBP were collected from December 2011 to November 2012. Ascitic fluid was collected by bedside tapping in blood culture bottle aseptically and immediately sent to a microbiology laboratory, Sir T Hospital, Bhavnagar, Gujarat, for microbiological examination. Bacterial examination and antibiotic sensitivity tests were carried out by standard microbiological techniques. Results: Of 217 clinically suspected cases of SBP, 71 (43.80%) had ascitic fluid polymorphonuclear cells (PMN) count ≥ 250/mm3. Among 71 cases, 31 (43.6%) cases were culture positive and 40 (56.4%) cases were culture-negative neutrocytic ascites. From 31 culture-positive cases, E. coli was isolated from 17 (54.9%) cases; Klebsiella spp. was isolated from 5 (16.2%) cases; Staphylococcus aureus was isolated from 6 (19.3%) cases; and Pseudomonas aeruginosa was isolated from 3 (9.6%) cases. All isolates were sensitive to cefotaxime and ceftriaxone. Conclusion: If diagnosed early, SBP can be treated with high success rate, thus ascitic fluid laboratory analysis including culture of all suspected patients will help in improving prognosis of the patients.

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Spontaneous bacterial peritonitis (SBP): clinical, laboratory and prognostic features. A single center experience

Cited by 8 publications

References 0 publications

Spontaneous Bacterial Peritonitis in the Medical Intensive Care Unit of a University Hospital in Egypt: Frequency, Bacteriological Profile, Risk Factors and Outcomes

Spontaneous Bacterial Peritonitis in the Medical Intensive Care Unit of a University Hospital in Egypt: Frequency, Bacteriological Profile, Risk Factors and Outcomes

Routine analysis of ascitic fluid for evidence of infection in children with chronic liver disease: Is it mandatory?

A study of bacteriological profile of ascitic fluid in suspected clinical cases of spontaneous bacterial peritonitis at a tertiary care hospital in India

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