scholarly journals Clinical and Bacteriological features of spontaneous bacterial peritonitis in Malagasy patients with Cirrhosis

2021 ◽  
Author(s):  
Andry Lalaina Rinà Rakotozafindrabe ◽  
Chantelli Iamblaudiot Razafindrazoto ◽  
Anjaramalala Sitraka Rasolonjatovo ◽  
Jean Désiré Ezra Lantonirina ◽  
Jolivet Auguste Rakotomalala ◽  
...  
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Multidrug Resistant ◽  
Ascites Fluid ◽  
Resistant Bacteria ◽  
Bacteriological Study ◽  
Bacterial Peritonitis ◽  
Biological Criteria ◽  
Cirrhotic Patients ◽  
The Mean ◽  
Major Pathogens

Abstract Background: Spontaneous bacterial peritonitis (SBP) represent frequent and serious complications in cirrhosis patients with ascites. Our aim was to describe the clinical and bacteriological characteristics of SBP in Madagascar.Methods: This is a 21-month prospective study between January 2018 and October 2019, including hospitalized patients with cirrhosis, with clinical and biological symptoms of SBP.Results: Thirty-three patients were included. The mean age was 48.09 ± 13.55 years (extremes: 19 – 78 years), the sex ratio was 3.12. Abdominal pain (55%), fever (36%), diarrhea (6%), hepatic encephalopathy (18%) are the most common symptoms. Gastrointestinal bleeding (18.18%) was the main risk factor to SBP. SBP was community-acquired in 87.88% of cases. A culture of ascites fluid was positive for 9 patients (27.27%). The infectious agents found were Escherichia coli (12.10%), Klebsiella pneumoniae (3%), Pseudomonas (3%), Streptococcus mitis (9.1%). Escherichia coli were wild with one case resistant to Ceftriaxone. The Klebsiella were multidrug resistant. The other two pathogens did not show resistance. After antibiotic therapy adapted to the antibiogram, healing was observed in 26 patients (78.78%). Seven patients (21.22%) died from various complications. All deceased patients had bacteria identified in ascites fluid.Conclusion: SBP defined according to clinical and biological criteria is apparently sterile in the majority of cases. Gram-negative bacteria were the major pathogens involved in SBP in cirrhotic patients. Escherichia coli and streptococcus were the most common pathogen isolated. Bacteriological study is essential to adapt antimicrobial to multidrug-resistant bacteria.

scholarly journals High Prevalence of Multidrug Resistant Bacteria in Cirrhotic Patients with Spontaneous Bacterial Peritonitis: Is It Time to Change the Standard Antimicrobial Approach?

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Jerônimo De Conto Oliveira ◽  
Enrique Carrera ◽  
Roberta C. Petry ◽  
Caroline Deutschendorf ◽  
Augusto Mantovani ◽  
...  
Keyword(s):  
Ascitic Fluid ◽  
Spontaneous Bacterial Peritonitis ◽  
Generation Cephalosporin ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Bacterial Peritonitis ◽  
High Prevalence ◽  
Cirrhotic Patients ◽  
End Stage

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.

Increasing frequency of gram-positive cocci and gram-negative multidrug-resistant bacteria in spontaneous bacterial peritonitis

2013 ◽  
Vol 33 (7) ◽  
pp. 975-981 ◽  
Author(s):  
Alexandra Alexopoulou ◽  
Nikolaos Papadopoulos ◽  
Dimitrios G. Eliopoulos ◽  
Apostolia Alexaki ◽  
Athanasia Tsiriga ◽  
...  
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
Bacterial Peritonitis ◽  
Gram Positive Cocci

Unsolved Issues in the Treatment of Spontaneous Peritonitis in Patients with Cirrhosis: Nosocomial Versus Community-acquired Infections and the Role of Fungi

2019 ◽  
Vol 14 (2) ◽  
pp. 129-135 ◽  
Author(s):  
Alberto Enrico Maraolo ◽  
Antonio Riccardo Buonomo ◽  
Emanuela Zappulo ◽  
Riccardo Scotto ◽  
Biagio Pinchera ◽  
...  
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Positive Outcome ◽  
Empiric Therapy ◽  
Multidrug Resistant ◽  
Empiric Antibiotic Therapy ◽  
Resistant Bacteria ◽  
Fungal Peritonitis ◽  
Bacterial Peritonitis ◽  
Healthcare Associated

Introduction:Historically, spontaneous bacterial peritonitis (SBP) has represented one of the most frequent and relevant infectious complications of advanced liver disease, and this is still valid today. Nevertheless, in recent years the role of fungi as causative pathogens of primary peritonitis in patients with cirrhosis has become not negligible. Another issue is linked with the traditional distinction, instrumental in therapeutic choice, between community-acquired and nosocomial forms, according to the onset. Between these two categories, another one has been introduced: the so-called “healthcare-associated infections”.Objective:To discuss the most controversial aspects in the management of SBP nowadays in the light of best available evidence.Methods:A review of recent literature through MEDLINE was performed.Results:The difference between community-acquired and nosocomial infections is crucial to guide empiric antibiotic therapy, since the site of acquisition impact on the likelihood of multidrug-resistant bacteria as causative agents. Therefore, third-generation cephalosporins cannot be considered the mainstay of treatment in each episode. Furthermore, the distinction between healthcare-associated and nosocomial form seems very subtle, especially in areas wherein antimicrobial resistance is widespread, warranting broad-spectrum antibiotic regimens for both. Finally, spontaneous fungal peritonitis is a not common but actually underestimated entity, linked to high mortality. Especially in patients with septic shock and/or failure of an aggressive antibiotic regimen, the empiric addition of an antifungal agent might be considered.Conclusion:Spontaneous bacterial peritonitis is one of the most important complications in patients with cirrhosis. A proper empiric therapy is crucial to have a positive outcome. In this respect, a careful assessment of risk factors for multidrug-resistant pathogens is crucial. Likewise important, mostly in nosocomial cases, is not to overlook the probability of a fungal ascitic infection, namely a spontaneous fungal peritonitis.

scholarly journals The validity of Triggering Receptor Expressed on Myeloid Cells (TREM-1) in diagnosis of Spontaneous Bacterial Peritonitis in cirrhotic patients

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
W Abdelmonsef ◽  
N A Abdelkader ◽  
G A Ismail ◽  
M M Elgaafary ◽  
Y A Abdelrazek
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Ascitic Fluid ◽  
Spontaneous Bacterial Peritonitis ◽  
Chronic Liver ◽  
Statistical Significant Difference ◽  
Bacterial Peritonitis ◽  
Significant Difference ◽  
Cirrhotic Patients ◽  
The Mean

Abstract Background Spontaneous bacterial peritonitis (SBP) is a serious complication in cirrhotic patients with ascites. Without early antibiotic treatment, this complication is associated with a 30-50% mortality rate. Recently we have evaluated the validity and utility of ascitic fluid triggering receptors expressed on myeloid cells-1 (TREM-1) levels for the diagnosis of SBP. Patients and Methods This was a Prospective case control study conducted on 60 patients with chronic liver disease and ascites divided into two group, group 1 (control) 30 patients without SBP and group 2 (SBP) 30 patients, admitted to the Tropical Medicine Department with ascites due to chronic liver disease. All patients were subjected to full history taking and clinical examination full laboratory investigations including complete blood picture liver and renal profiles, C reactive protein, viral markers, abdominal ultrasound, UGI endoscopy and ascitic fluid sampling for biochemical testing, total and differential cell count, microbiological culture and TREM-1 level. Results There was high statistical significant difference between the two groups in the base level of TREM-1 in which the mean was 1280 pg/ml (1136.9) with level range between (580---4500pg/ml) in SBP versus mean 129.9 pg/ml (51.9) with level range between (60-250pg/ml) in the control group. Also there was a statistical significant difference in the level of TREM-1 before and after treatment in the SBP patients in which the mean of TREM-1 before treatment was 1280.6 pg/ml (1136.9) with level range between (580-4500pg/ml) versus mean 376.2 pg/ml (78.4) and level range between (260-560 pg/ml) after the treatment. Conclusion our data indicate that the measurement of ascitic fluid TREM-1 is rapid, easy and valid test in the diagnosis and follow up of chronic liver disease patients with SBP.

scholarly journals Spontaneous Bacterial Peritonitis among Cirrhotic Patients: Prevalence, Clinical Characteristics, and Outcomes

2021 ◽  
Vol 11 (1) ◽  
pp. 227
Author(s):  
Naim Abu-Freha ◽  
Tal Michael ◽  
Liat Poupko ◽  
Asia Estis-Deaton ◽  
Muhammad Aasla ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ascitic Fluid ◽  
Spontaneous Bacterial Peritonitis ◽  
Cox Regression ◽  
Positive Culture ◽  
Multidrug Resistant ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients ◽  
Escherichia Coli Bacteria

(1) Background: Spontaneous bacterial peritonitis (SBP) is a feared complication of liver cirrhosis. We investigated the prevalence of SBP, positive ascitic fluid cultures, and risk factors for mortality. (2) Methods: A retrospective analysis of all patients with cirrhosis hospitalized or in follow-up in a single center between 1996 and 2020. The clinical data, long-term complications, and mortality of SBP patients were compared with those of non-SBP patients. Ascitic fluid positive culture was compared with those without growth. (3) Results: We included 1035 cirrhotic patients, of which 173 (16.7%) developed SBP. Ascitic fluid culture growth was found in 47.4% of the SBP cases, with Escherichia coli bacteria detected in 38%, 24.4% grew ESBL-producing bacteria, and 14.5% displayed multidrug resistance. In a Cox regression model, SBP, male sex, prolonged INR at diagnosis, and hepatocellular carcinoma were found to be risk factors for mortality in cirrhotic patients. The long-term all-cause mortality was 60% in non-SBP and 90% in SBP patients. (4) Conclusions: Only a minority of cirrhotic patients developed SBP, 47.4% of which had positive ascitic fluid cultures with high antibiotic resistance. Growth of ESBL and multidrug resistant organisms is becoming more frequent in the clinical setting, reaching SBP mortality of 90%.

Mean platelet volume indicator for systemic inflammation in cirrhotic patients with spontaneous bacterial peritonitis

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Khaled Mohamed Abd El-Wahab ◽  
Moataz Mohamed Sayed ◽  
Mohamed Osama Ali ◽  
Abd El-Azem Mostafa Abd El-Azem
Keyword(s):  
Mean Platelet Volume ◽  
Spontaneous Bacterial Peritonitis ◽  
Platelet Volume ◽  
Bacterial Peritonitis ◽  
Function Test ◽  
Group A ◽  
Cirrhotic Patients ◽  
The Mean ◽  
Group B ◽  
Ascetic Fluid

Abstract Introduction spontaneous bacterial peritonitis (SBP) is the most common infection in patients with cirrhosis [1] .Spontaneous bacterial peritonitis is found in patients where besides the increase of polymorphonuclear counting, they present a positive result of culture [2] . The BMN count as not always quickly available in clinical practice and the culture result usually takes 72 hours or more [3] .The use of additional markers that are rapidly and easily applicable, may add significant benefit for predicting the development of spontaneous bacterial peritonitis and achieving diagnostic accuracy [4] .Platelet size is a determinant factor of platelet proinflammatory functions. Several studies have found relationship between the mean platelet volume (MPV) and pro-inflammatory conditions, particularly acute infections [5] . Aim to identify a mean platelet volume (MPV) cutoff value which should be able to predict the presence of sponataneous bacterial peritonitis. Settings and designs a cross sectional observational study, carried out on 40 patients with AFI and 40 patients without AFI. Methods Patients were classified into two groups, group A (SBP) which included 40 patients with ascetic fluid PMN count ≤ 250 cells/mm3 and group B (non/SBP) which included another 40 patients with ascetic fluid PMN count < 250 cells/mm3. All studied patients were subjected to history taking, Clinical examination and routine laboratory investigations including: CBC including platelet number and MPV, liver function test including (ALT, AST, albumin, and direct & total bilirubin), kidney function test including (BUN &creatinine), PT, PTT, INR, ESR and CRP .Abdominal-pelvic ultrasonography was done for all patients. Aspirated ascetic fluid samples were immediately examined for bacteriological cultures. Statistical analysis used Statistical presentation and analysis of the present study was conducted, using the mean, standard deviation, independent samples t-test, Chi-square, Mann-Whitney U test and Analysis of variance [ANOVA] tests by SPSS version 22 software .Tukey test was used .Receiver operating characteristic (ROC) curve analysis was used to identify optimal cut-off values of MPV and with maximum sensitivity and specificity for differentiation of cirrhotic patients with SBP from those without SBP. Spearman’s correlation analysis was done. Results MPV was significantly higher in SBP-patients (Group A) than that of non-SBP patients (Group B) (11.6820±1.19303 fL versus 9.0325±1.12441 fL) (P-value = 0.001) .MPV has positive correlation with Ascitic sample TLC and Ascitic sample PMNC in Group A. ROC curve shows that MPV cut off value is10.25with 85% sensitivity and 75% specificity . Conclusion MPV may serve as a non-invasive, cheap and rapid test for detection and diagnosis of spontaneous bacterial peritonitis (SBP) with a sensitivity and specificity of 85% and 75% respectively.

scholarly journals SPONTANEOUS BACTERIAL PERITONITIS

2006 ◽  
Vol 13 (02) ◽  
pp. 201-205
Author(s):  
MUHAMMAD IMRAN ◽  
Haroon-ur- Rashid ◽  
SHOAIB NAIYAR HASHMI ◽  
Assawar Hussain ◽  
ASHFAQ ALTAF
Keyword(s):  
Ascitic Fluid ◽  
Spontaneous Bacterial Peritonitis ◽  
Military Hospital ◽  
Routine Examination ◽  
E Coli ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients ◽  
The Mean ◽  
Culture Positive ◽  
Culture Negative

Objective: To evaluate the prevalence, diagnostic criteria and microbialspectrum of spontaneous bacterial peritonitis (SBP) and its variants in cirrhotic patients with ascites. Design: A hospitalbased prospective study carried out in cirrhotic patients with ascites. Place and duration of Study: The study wasconducted in the Department of Medicine Military Hospital Rawalpindi during October 2000 to March 2002. Subjectand Methods: One hundred and eighty consecutive patients of cirrhotic liver between the ages of 20-65 yearspresenting with ascites reporting to outdoor patient department of Military Hospital Rawalpindi were included in thestudy. The diagnosis of cirrhosis was made on history, clinical examination and the ultrasonographic findings. Thesepatients were subjected to ascites fluid tap and the patients were divided into SBP and non-SBP groups in the light ofresults of ascitic fluid routine examination and culture. The SBP group was further categorized into culture positive SBP,culture negative neutrocytic ascites (CNNA) and bacterascites (BA) on the basis of culture results and total leukocytecount, absolute polymorphonuclear leukocyte count per cubic mm of ascitic fluid. Results: The study included 144males and 36 females having cirrhosis with ascites. The mean age of these patients was 52.32±7.87 years. On thebasis of routine examination and culture of tapped ascitic fluid from these cases 57 of 180(31.66%) patients werediagnosed to have SBP or its variants. In addition to classic SBP in 18(31.58%) patients, its variants namely culturenegative neutrocytic ascites and bacterascites were detected in 37(64.92%) and two (3.5%) cases respectively. E. coliwas the most frequently cultured organism. It was isolated in 12 cases of SBP (60%). In 4 cases (20%) Klebsiella wascultured whereas Proteus mirabilus and Streptococcus were reported in two cases (10%) each. Conclusion: This studyindicates that spontaneous bacterial peritonitis is common and potentially fatal complication in cirrhotic patients withascites. E. coli is the most frequent offending organism.

Microbial epidemiology in cirrhotic patients with spontaneous bacterial peritonitis in Vienna

2013 ◽  
Vol 51 (05) ◽  
Author(s):  
P Schwabl ◽  
K Soucek ◽  
T Bucsics ◽  
M Mandorfer ◽  
A Blacky ◽  
...  
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients
Sign in / Sign up

Export Citation Format

Share Document