To Study the Incidence, Predictive Factors and Clinical Outcome of Spontaneous Bacterial Peritonitis in Patients of Cirrhosis with Ascites

Paul, Kavita; Kaur, Jasmine; Kazal, Harbans Lal

doi:10.7860/jcdr/2015/14855.6191

Cited by 24 publications

(26 citation statements)

References 12 publications

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“…Furthermore, a highly significant correlation between serum procalcitonin and INR was observed. This comes in accordance with the study done by Kavita Paul et al, (23) who reported that INR was significantly higher in patients with SBP compared with those without SBP.…”

Section: Results:-supporting

confidence: 93%

The Role of Serum Procalcitonin Levels in Predicting Ascitic Fluid Infection in Ascitic Patients Admitted to Zagazig University Hospital in 2014.

Farag¹,

Labib²

2016

IJAR

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Background: It is difficult to diagnose spontaneous bacterial peritonitis (SBP) early in ascitic patients. The aim of the study was to measure serum procalcitonin (PCT) levels to obtain an early diagnostic indication of SBP in ascitic patients. Methods: A total of 62 patients (mean age: 54.4 ± 10.7, 77.4% were males) hospitalized due to cirrhosis (n=57) or non-cirrhosis related (n=5) ascites were included in this study. Spontaneous bacterial peritonitis (SBP, 19.4%), culture-negative SBP (35.5%), bacterascites (6.5%), sterile ascites (30.6%) and non-cirrhotic ascites (8.1%) groups were compared in terms of procalcitonin levels in predicting ascites infection. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of procalcitonin levels. Results: Culture positivity was determined in 25.8% of overall population. Serum procalcitonin levels were determined to be significantly higher in patients with positive bacterial culture in ascitic fluid compared to patients without culture positivity (median (min-max): 3.35 (0.05-6.4) vs. 0.2 (0.05-1.9), p=0.000). Using ROC analysis, a serum procalcitonin level of >1.9 ng/mL (area under curve (AUC): 0.791, sensitivity: 75%, specificity: 100%, positive predictive value 100% and negative predictive value 92%) were determined to accurately help the diagnosis of bacterial peritonitis. Conclusion: According to our findings, determination of serum procalcitonin levels seems to provide accurate and rapid diagnosis of ascitic fluid infection.

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Section: Results:-supporting

confidence: 93%

The Role of Serum Procalcitonin Levels in Predicting Ascitic Fluid Infection in Ascitic Patients Admitted to Zagazig University Hospital in 2014.

Farag¹,

Labib²

2016

IJAR

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“…Diagnostic puncture frequently has an important role in the diagnosis of SBP (5). In a previous study, the diagnosis was based on bacterial positive cultures in ascitic fluid and/or the testing of an elevated absolute fluid polymorphonuclear neutrophil (PMN) count in the ascites (>250/mm 3 ) without any obvious abdominal intra-operatively detected source of infection (6).…”

Section: Introductionmentioning

confidence: 99%

Emerging Gram‑positive bacteria and drug resistance in cirrhosis patients with spontaneous bacterial peritonitis: A retrospective study

et al. 2019

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Spontaneous bacterial peritonitis (SBP) is one of the most severe complications in liver cirrhosis (LC) patients with ascites. The aim of the present study was to retrospectively analyze the bacterial spectrum and drug resistance in ascites culture of patients with SBP. A total of 3, 189 patients with ascites were enrolled in the present study, including 912 LC patients, of which 247 had SBP. It was revealed that in the 3, 189 patients, the ratio of SBP exhibited annual increases, especially in 2015, and this trend remained when cases were divided into two groups: Group A (admission, 2011–2013) and Group B (admission, 2014–2016). The 247 SBP patients were then stratified into two groups: Group 1 (admission, 2011–2013) and Group 2 (admission, 2014–2016). The rate of infection with gram-positive bacteria (GPB) was markedly higher in Group 2 compared with Group 1. Over time, GPB and gram-negative bacteria (GNB) were increased, while the increase of GPB was greater than that of GNB. Direct bilirubin and C-reactive protein levels, and the positive rate of ascites culture in Group 2 were greater than in Group 1. Furthermore, marked differences in serological and ascitic indexes or pathogeny, as well as complications between the patients with GPB and GNB infection were observed. The results regarding drug sensitivity revealed that the resistance rate of GPB and GNB to penicillin (ampicillin) was 100%, while the resistance rate to amikacin, imipenem, meropenem and piperacillin/tazobactam was 0% for GNB, and similarly, the resistance rate to vancomycin, teicoplanin, amikacin and linezolid was 0% for GPB. The results suggested that combined use of ampicillin/sulbactam or piperacillin/tazobactam should be selected forempirical therapy. In cases of nosocomial infection, these drugs should be combined with vancomycin, linezolid or teicoplanin when required.

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“…Ascites culture could be negative in up to 60% of patients with AFI [ 14 , 24 ]. The bacterial isolates in AFI are different in children versus adults, with Gram-negative organisms, mainly Escherichia coli , being most common in adults [ 24 , 25 ] and gram positive in children [ 26 , 27 ]. Our results revealed that gram-positive bacteria were slightly more prevalent than gram-negative isolates.…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of AFI depends on severity of liver dysfunction, being higher in advanced liver disease [ 34 ]. High serum bilirubin is an important predictor for development of AFI in studies conducted on adults [ 5 , 25 , 35 ]. This finding was not observed in pediatric studies as elevated bilirubin is a common finding in many cholestatic liver diseases of infancy and childhood and is not necessarily associated with advanced liver disease as in adults.…”

Section: Discussionmentioning

confidence: 99%

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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To Study the Incidence, Predictive Factors and Clinical Outcome of Spontaneous Bacterial Peritonitis in Patients of Cirrhosis with Ascites

Cited by 24 publications

References 12 publications

The Role of Serum Procalcitonin Levels in Predicting Ascitic Fluid Infection in Ascitic Patients Admitted to Zagazig University Hospital in 2014.

The Role of Serum Procalcitonin Levels in Predicting Ascitic Fluid Infection in Ascitic Patients Admitted to Zagazig University Hospital in 2014.

Emerging Gram‑positive bacteria and drug resistance in cirrhosis patients with spontaneous bacterial peritonitis: A retrospective study

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

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