SAT-009-Pharmacokinetics of ertapenem in plasma and ascitic fluid in cirrhotic patients with spontaneous bacterial peritonitis

Introduction. Spontaneous bacterial peritonitis (SBP) has a deleterious clinical impact in end-stage liver disease, and multidrug resistance has increased, raising concern about effectiveness of traditional antibiotic regimens. Patients and Methods. Single-center retrospective study of ascitic fluid infections in cirrhotic patients. Results. We analyzed medical records related to 2129 culture-positive ascitic fluid and found 183 samples from cirrhotic patients. There were 113 monobacterial SBP cases from 97 cirrhotic patients; 57% of patients were male; hepatitis C and alcohol were the main etiologies for cirrhosis. Multidrug resistant bacteria were isolated in 46.9% of SBP samples, and third-generation cephalosporin and quinolone resistant reached 38.9% and 25.7% of SBP cases. Conclusion. SBP due to multidrug resistant bacteria is a growing problem, and one should consider reported resistance profiles for the decision-making process of empirical first-line treatment prescription.

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Human Amnion-Derived Mesenchymal Stromal Cells in Cirrhotic Patients with Refractory Ascites: A Possible Anti-Inflammatory Therapy for Preventing Spontaneous Bacterial Peritonitis

Stem Cell Reviews and Reports ◽

10.1007/s12015-020-10104-8 ◽

2021 ◽

Author(s):

Mariangela Pampalone ◽

Simona Corrao ◽

Giandomenico Amico ◽

Giampiero Vitale ◽

Rossella Alduino ◽

...

Keyword(s):

Ascitic Fluid ◽

Mesenchymal Stromal Cells ◽

Stromal Cells ◽

Spontaneous Bacterial Peritonitis ◽

Refractory Ascites ◽

M2 Macrophage ◽

Human Amnion ◽

Bacterial Peritonitis ◽

Cirrhotic Patients ◽

Anti Inflammatory

AbstractCirrhosis is associated with dysregulated immune cell activation and immune dysfunction. These conditions modify gut flora, facilitate bacterial translocation, and increase susceptibility to bacterial peritonitis and consequent systemic infections by dramatically affecting long-term patient survival. Human amnion-derived mesenchymal stromal cells (hA-MSCs) exert immunomodulatory potential benefit, and have the ability to modulate their actions, especially in situations requiring immune activation through mechanisms not fully understood. In this study, we aimed to investigate, in vitro, the immunostimulant or immunosuppressive effects of hA-MSCs on cellular components of ascitic fluid obtained from cirrhotic patients with refractory ascites. We found that hA-MSCs viability is not affected by ascitic fluid and, interestingly, hA-MSCs diminished the pro-inflammatory cytokine production, and promoted anti-inflammatory M2 macrophage polarization. Moreover, we found that there was no simultaneous significant decrease in the M1-like component, allowing a continual phagocytosis activity of macrophages and NK cells to restore a physiological condition. These data highlight the plasticity of hA-MSCs’ immunomodulatory capacity, and pave the way to further understanding their role in conditions such as spontaneous bacterial peritonitis. Graphical abstract

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The pattern of microbial flora in Spontaneous bacterial peritonitis in Cirrhotic patients

Journal of Rawalpindi Medical College ◽

10.37939/jrmc/vol24.iss1.13 ◽

2020 ◽

pp. 62-67

Author(s):

Sehrish Jahan Asif ◽

Murataza Gondal ◽

Shahida Parveen ◽

Sumera Mushtaq ◽

Shumaila Awan ◽

...

Keyword(s):

Ascitic Fluid ◽

Spontaneous Bacterial Peritonitis ◽

Cross Sectional Study ◽

Cross Sectional ◽

E Coli ◽

Bacterial Peritonitis ◽

Serious Infection ◽

Culture Sensitivity ◽

Cirrhotic Patients ◽

Biochemical Examination

Background: Spontaneous bacterial peritonitis (SBP) is the bacterial infection of ascitic fluid in the absence of other apparent causes. It is the most prevalent and serious infection in cirrhosis and leads to significant morbidity and mortality. The frequency of SBP in hospitalized patients with cirrhosis varies from 7 to 23% in the west and it is around 33% in Pakistan. Our study aim was to determine the frequency of microbial organisms isolated from spontaneous bacterial peritonitis in cirrhotic patients. Material and Methods: We did a cross-sectional study at the Department of Medicine, Fauji Foundation Hospital Rawalpindi for 6 months. Cirrhosis was diagnosed on the bases of clinical, biochemical and ultrasonography findings. Peripheral blood samples were obtained for the evaluation of complete blood cell count, polymorphonuclear leukocyte count, albumin and coagulation parameters. At the same time, the patients underwent paracentesis and a 20ml ascitic fluid sample was taken for culture sensitivity along with routine biochemical examination from the pathology department lab at our hospital. Results: A total of 150 patients were enrolled according to the inclusion criteria of the study. The mean age (yrs) of patients was 32.3+9.31. The frequency and percentages of male and female patients were 70 (46.7) and 80 (53.3) respectively. Frequency and percentages of E Coli and streptococcal pneumonia were 94 (62.7) and 34 (22.7) respectively, whereas frequency and percentages of staph aureus and Klebsiella were 22 (14.7). Conclusion: SBP is quite common in patients with cirrhosis. It should be suspected in all such cases presenting with typical or atypical features. E Coli was the most common causative organisms in our study but gram-positive organisms were quite frequent as well. Keywords: SBP, Cirrhosis, Peritonitis.

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High Levels of Tumor Necrosis Factor- and Interleukin-6 in the Ascitic Fluid of Cirrhotic Patients with Spontaneous Bacterial Peritonitis

Clinical Infectious Diseases ◽

10.1093/clinids/17.2.218 ◽

1993 ◽

Vol 17 (2) ◽

pp. 218-223 ◽

Cited By ~ 36

Author(s):

F. Zeni ◽

B. Tardy ◽

M. Vindimian ◽

C. Comtet ◽

Y. Page ◽

...

Keyword(s):

Tumor Necrosis Factor ◽

Ascitic Fluid ◽

Interleukin 6 ◽

Spontaneous Bacterial Peritonitis ◽

Tumor Necrosis ◽

Bacterial Peritonitis ◽

Cirrhotic Patients ◽

Necrosis Factor

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Microbial spectrum and antibiotic sensitivity in cirrhotic patients with spontaneous bacterial peritonitis

10.53350/pjmhs2115113123 ◽

2021 ◽

Vol 15 (11) ◽

pp. 3123-3125

Author(s):

Irfan Ahmad ◽

Muhammad Shahbaz Hussain ◽

Muhammad Shoaib Akhtar

Keyword(s):

Ascitic Fluid ◽

Spontaneous Bacterial Peritonitis ◽

Antibiotic Sensitivity ◽

High Sensitivity ◽

Resistance Rate ◽

Medical Department ◽

College Hospital ◽

Culture Bottle ◽

Bacterial Peritonitis ◽

Cirrhotic Patients

Objective: There are reports of changing microbial profile of ascitic fluid in spontaneous bacterial peritonitis (SBP) and developing resistance of these bacteria to commonly used antibiotics. This study was done to determine the micro-organism causing SBP and their sensitivity to various antibiotics. Setting and Methods: This observational study was done in Medical department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from March to November 2019. Thirty five cirrhotic patients with ascites admitted in ward for various reasons and having positive ascitic fluid culture were included in the study. Exclusion criteria was presence of secondary bacterial peritonitis. Ten ml of ascitic fluid was inoculated in blood culture bottle and sent immediately to hospital laboratory. Results: The mean age of these 35 patients was 48.94 ± 13.51 years with a range of 19 to 80 years. Twenty (57.1 %) patients were male and 15 (42.9 %) were female. Bacteria that had caused SBP were E.coli (62.9 %), staph aureus (11.4 %), klebsiella (8.6 %), streptococci (8.6 %), gram positive cocci (5.7 %) and pseudomonas aeruginosa (2.8 %). Imipenem had high sensitivity rate (100 %) along with amikacin (82.9 %) and cefoperazone-sulbactam (68.6 %). Sensitivity of these organisms to other commonly used antibiotics were: ciprofloxacin 57.1 %, ofloxacin 40 %, norfloxacin 37.1 %, ceftazidime 34.3 %, ceftriaxone 31.4 % and piperacillin-tazobactam 25.7 %. Conclusion: We found that E.coli was the commonest bacteria causing SBP, and ceftriaxone and ciprofloxacin have significantly high resistance rate in these patients. Key words: cirrhosis, ascitic fluid, spontaneous bacterial peritonitis, antibiotic sensitivity

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Prevalence and Risk Factors for Unsuspected Spontaneous Ascitic Fluid Infection in Cirrhotics Undergoing Therapeutic Paracentesis in an Outpatient Clinic

10.53350/pjmhs2115113470 ◽

2021 ◽

Vol 15 (11) ◽

pp. 3470-3473

Author(s):

Muhammad Omar Khan ◽

Muhammad Ikram Shah ◽

Muhammad Imran ◽

Shazia Siddiq ◽

Narindar Kumar ◽

...

Keyword(s):

Liver Disease ◽

Hepatitis C ◽

Hepatitis B ◽

Fatty Liver ◽

Ascitic Fluid ◽

Fatty Liver Disease ◽

Spontaneous Bacterial Peritonitis ◽

Bacterial Peritonitis ◽

Cirrhotic Patients ◽

Aseptic Conditions

Background and Aim: Ascites is a common complication of liver cirrhosis, making patients more vulnerable to infectious diseases such as spontaneous bacterial peritonitis. There hasn't been much research done on infectious ascitic fluid in asymptomatic patients. The purpose of the study was to find out the infectious asymptomatic ascitic fluid incidence and risk factors in liver cirrhotic patients. Materials and Methods: This cross-sectional study was conducted on 76 cirrhotic patients who underwent therapeutic paracentesis between September 2020 and February 2021 in an outpatient department of Jinnah Medical College, Peshawar. An 18-G catheter was used to collect ascitic fluid under strict aseptic conditions. Total and differential leucocyte counts, as well as total protein and albumin levels, were measured. The fluid was injected for bacterial culture of aerobic type and anaerobic blood culture bottles (10 mL each) under strict aseptic conditions. Individuals with abdominal pain, recent gastrointestinal bleeding, fever, SBP previous history, hepatic encephalopathy, impaired renal function, and treatment with antibodies were excluded. Written informed consent and ethical approval were taken prior to study conduction. Demographic details, liver disease severity, and etiology were noted along with laboratory technique-based biochemical tests, ascitic fluid count, and culture. SPSS version 20 was used for data analysis. Results: A total of 192 paracenteses were done on 76 liver cirrhosis patients with an average of 2.53 per patient. The overall mean age was 43.65±8.7 years. Of the total 76 patients, 55 (72.4%) were male and 21 (27.6%) were female. The ascites duration for study inclusion was 3 to12 months. Hepatitis B, fatty liver disease, hepatitis C, and drugs were the major causes of cirrhosis among study patients. The prevalence of Hepatitis B, fatty liver disease, hepatitis C, and drugs was 27 (35.5), 23 (30.3%), 11 (14.5%), and 15 (19.7%) respectively. The hepatic encephalopathy and variceal bleeding history were present in 16 (33.3%) and 32 (66.7%) respectively in a total of 48 (63.2%) cirrhosis patients. The class C and child Pugh class had 23 (30.3%) and 53 (69.7%) respectively. Null mortality was found in patients due to infection caused by spontaneous ascitic fluid. Conclusion: Our study found that hepatitis B, fatty liver disease, hepatitis C, and drugs were the major causes of cirrhosis. Asymptomatic ascitic fluid infection was extremely rare in cirrhotic patients who attended an outpatient clinic and underwent therapeutic paracentesis. Additionally, our study found that the peritoneal fluid asymptomatic spontaneous infection is rare among cirrhotic patients undergoing outpatient base therapeutic paracentesis. Further investigation for ascitic fluid analysis's role in such infection without treatment is to be carried out. Keywords: Ascitic fluid; Cirrhosis; Infection; Therapeutic paracentesis; Spontaneous bacterial peritonitis

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Study on ascitic fluid protein level in cirrhotic patients with spontaneous bacterial peritonitis

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v35i2.3023 ◽

2009 ◽

Vol 35 (2) ◽

pp. 41-43 ◽

Cited By ~ 1

Author(s):

M. Golam Mustafa ◽

M. Ayub Al Mamun ◽

A.K.M. Khorshed Alam

Keyword(s):

Ascitic Fluid ◽

Total Protein ◽

Protein Level ◽

Spontaneous Bacterial Peritonitis ◽

Bacterial Peritonitis ◽

Complement 3 ◽

Advanced Cirrhosis ◽

Cirrhotic Patients ◽

Hepatic Synthesis

Complement 3 is an important component of ascitic fluid total protein, which offers local defence against infection of the ascitic fluid. Hepatic synthesis of complement 3 as well as other proteins and their concentrations in ascitic fluid is significantly reduced in patients with advanced cirrhosis. The level of protein in ascitic fluid in cirrhotic patients with spontaneous bacterial peritonitis was compared with that in patients without spontaneous bacterial peritonitis. Ascitic fluid protein level in spontaneous bacterial peritonitis (n=15) was 1.1 ± 0.3 g/dL whereas it was 1.5 ± 0.5 g/dL in patients without spontaneous bacterial peritonitis (n=15). In conclusion, this study suggests that, ascitic fluid protein level is significantly (p=0.008) reduced in cirrhotic patients who develop spontaneous bacterial peritonitis.Keywords: Ascitic fluid; Bacteria; Cirrhosis; PeritonitisOnline: 11 August 2009DOI: 10.3329/bmrcb.v35i2.3023Bangladesh Med Res Counc Bull 2009; 35: 41-43

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