scholarly journals Serial Ascitic Fluid Analysis – Prognostic Marker for Adverse Outcome in Spontaneous Bacterial Peritonitis in Liver Cirrhosis?

2015 ◽  
Vol 4 (1) ◽  
pp. 6-12
Author(s):  
Rahul Pathak ◽  
Annette Von Thun ◽  
Kumar Vikram Singh ◽  
Prem Khadga ◽  
Shashi Sharma
Keyword(s):  
Ascitic Fluid ◽  
Repeated Measures ◽  
Spontaneous Bacterial Peritonitis ◽  
Hospital Admissions ◽  
Tertiary Care ◽  
Roc Curves ◽  
Predictive Values ◽  
Bacterial Peritonitis ◽  
Fluid Analysis ◽  
Cirrhotic Patients

Background: Cirrhosis is a frequent cause of hospital admissions in Nepal with spontaneous bacterial peritonitis (SBP) being a major determinant of mortality. Limited diagnostic options preclude early risk stratification to improve patient outcomes. We assessed the predictive value of polymorphonuclear leukocyte counts (PMNs) and its association with mortality in hospitalized SBP patients.Methods: We examined 51 cirrhotic patients diagnosed with SBP in a prospective case-control study admitted to a Nepali tertiary care facility from February 2010 to November 2012. Serial paracentesis and ascitic fluid analysis were performed at admission, 24, and 48 hours. Receiver operating characteristic (ROC) curves, repeated measures analysis of variance, and logistic regression evaluated ascitic PMNs as predictors of mortality.Results: Deceased patients demonstrated significantly elevated mean circulating and ascitic PMNs. Ascitic PMNs in the non-survivors were significantly elevated upon admission and at 24 and 48 hours. These differences were significant based on absolute counts, relative differences and trends across time. ROC curves provided diagnostic thresholds (1600, 860, 500 cells/mm3) distinguishing the two groups upon presentation, at 24 and 48 hours respectively, with high sensitivities (100%), specificities (82.5-97.5%), and positive predictive values (52.4-84.6%). After adjusting for age and case severity, there was a 9.1-fold greater odds of mortality upon admission, for every increase of 500 ascitic PMNs.Conclusion: In this study of cirrhotic patients with SBP, in-hospital mortality was associated with persistently elevated ascitic PMNs. Ascites PMN thresholds offer a quick, low-tech option to risk stratify patients, prognosticate mortality, and guide patient care in low resourced settings. Journal of Advances in Internal Medicine 2015;04(01):6-12

scholarly journals Clinico-bacteriological profile of spontaneous bacterial peritonitis in cirrhosis of liver with ascites

2019 ◽  
Vol 7 (11) ◽  
pp. 4256
Author(s):  
Shewtank Goel ◽  
Pooja Tripathi Pandey ◽  
Abhay Kumar ◽  
Nidhish Kumar ◽  
Deval Kumar Arora ◽  
...  
Keyword(s):  
Ascitic Fluid ◽  
Spontaneous Bacterial Peritonitis ◽  
Tertiary Care ◽  
Coagulase Negative Staphylococcus ◽  
Bacterial Peritonitis ◽  
Rebound Tenderness ◽  
Fluid Analysis ◽  
Cirrhotic Patients ◽  
Cirrhosis Of Liver ◽  
Culture Negative

Background: A good and an effective empirical treatment of SBP is not possible unless bacteriological spectrum and their antibiogram is clear. This becomes more important in country like India due to high antibiotic resistance.  Authors aim was to assess the prevalence of SBP, clinical and microbiological profile of its variants, in patients with cirrhosis seeking care at a tertiary care teaching hospital.Methods: Patients of liver cirrhosis with ascites seeking care at study subject during January- December 2018 formed the study population. Diagnosis was based on clinical examination, biochemical investigation and ultrasonography. Diagnostic abdominal paracentesis was performed on subjects within 24 hours of admission. Ascitic fluid was aspirated. It was sent for microbiological examination.Results: Prevalence of SBP was 16.12%. Out of total ten subjects with Spontaneous Bacterial Peritonitis (SBP), six subjects were of Culture Negative Neutrocytic Ascites (CNNA). Thus most common (60%), variant of Spontaneous Bacterial Peritonitis (SBP) was Culture Negative Neutrocytic Ascites (CNNA). Prevalence of Mono-microbial Non-neutrocytic Bacterascites (MNBA) and Classic-Spontaneous Bacterial Peritonitis (C-SBP) was 20%.  Two subjects found positive for MNBA, Staphylococcus aureus and Acinitobacter spp. was detected in each patient. Klebseila pneumonia, Escherichia coli and Coagulase negative Staphylococcus were found in ascitic fluid culture of C-SBP. In clinical variants of SBP, 80% subject’s complaint about abdominal pain. Hepatic-encephalopathy and fever was seen in 7(70%) patients. Rebound tenderness was seen among 60%.Conclusions: Diagnostic paracentesis should be advised to all cirrhotic patients with ascites. Ascitic fluid analysis should be sent for better selection of antibiotics thus better outcome of cirrhotic patients.

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

2019 ◽  
Vol 70 (1) ◽  
pp. e628-e629
Author(s):  
Alberto Amador ◽  
Sara Cobo ◽  
Ariadna Padulles ◽  
Raul Rigo ◽  
Inmaculada Grau ◽  
...  
Keyword(s):  
Ascitic Fluid ◽  
Spontaneous Bacterial Peritonitis ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients

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.

Spontaneous Bacterial Peritonitis in Cirrhotic Patients Hospitalized in the Tertiary Care Hospital

2011 ◽  
Vol 140 (5) ◽  
pp. S-953
Author(s):  
Arslan Kahloon ◽  
Rodjawan Supakul ◽  
Paul Y. Kwo ◽  
Raj Vuppalanchi ◽  
Marwan Ghabril ◽  
...  
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients

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

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

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

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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