The study of prognostic factors in resistant spontaneous bacterial peritonitis in cirrhotic patients

Abstract

Background Spontaneous Bacterial Peritonitis is the most common form of infection seen in-patient with cirrhosis and is responsible of hospital mortality rate of approximately 32%, the increasing trend of resistance associated with low treatment efficacy of traditional therapy in nosocomial infection. It has been considered a life-threatening infection that requires a prompt diagnosis and treatment. Aim To evaluate the effect of certain prognostic factors namely Child -Pugh score, MELD Score and isolated organisms by bacterial cultures & Identifying organisms responsible for resistant SBP will guide in modification of antimicrobial treatment regimen. Methods A prospective cohort Study was conducted on 100 Egyptian cirrhotic and Ascetic patients for whom suspected for Spontaneous bacterial peritonitis (SBP) with no prior antimicrobial treatment. SBP and RSBP(Resistant spontaneous bacterial peritonitis) was diagnosed through history-taking through examination, clinical assessment and laboratory investigations, including ascetic fluid study analysis and the detection of culture sensitivity, recruited from the Gastrointestinal and Hepatology Unit of Nasser Institute Hospital, over a period from December 2016 to April 2017. Results Our study showed that out of 100 cirrhotic and Ascetic, out of 100; 60 were diagnosed SBP, out of those 60 resistant SBP were diagnosed in 30 patients with culture positive that responded on 2nd line treatment; Meropenem; 1g IV (with dose modification according creatinine clearance level) every 8 h for 5 days are the cases group and remained 30 that respond on the usual 1st line treatment; 2g of intravenous (IV) Cefotaxime (CTX) every 8h for 5days; are the control group. We found that there was no statistical significant difference between the studied groups as regards age and sex, Fever and abdominal pain were the most frequent manifestations in both group. There was statistically significant difference between both groups according to the grade of Ascites, Hepatic encephalopathy and at the peritoneal fluid analysis after 48 h of 2 gram of CTX for TLC and Neutrophil & also Cl, Glucose and LDH (P value<0.05). The RSBP prediction by Child score at cut off value ≥9.5 and the most frequent organism is Klebsiella in cultures results among RSBP which is being responded on Meropenem treatment. Conclusion RSBP associated with child c patients at cut off value≥9.5 so Child score is more useful as prognostic tool than MELD score although MELD score has higher accuracy prediction than Child score because it is vulnerable in Laboratory measurement.