|
1
|
Haedge F, Bruns T. Antibiotics in decompensated liver disease - who, when and for how long? Expert Rev Gastroenterol Hepatol 2025; 19:111-130. [PMID: 39921440 DOI: 10.1080/17474124.2025.2464044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Revised: 01/26/2025] [Accepted: 02/04/2025] [Indexed: 02/10/2025]
Abstract
INTRODUCTION Bacterial infections are a leading cause of hospitalization and mortality in patients with decompensated cirrhosis. Antibiotic prophylaxis in cirrhotic patients has demonstrated significant short-term reductions in bacterial infections in randomized controlled trials, but at the cost of drug resistance and with uncertain survival benefits. AREAS COVERED This review examines antibiotic use in cirrhosis, focusing on patients most likely to benefit from antibiotic prophylaxis, management strategies for infections through risk-based antibiotic selection and timely treatment initiation, challenges posed by the emergence of multidrug-resistant organisms, and principles of antimicrobial stewardship. EXPERT OPINION The efficacy of prophylaxis has decreased over time, and current registry data have questioned its use, emphasizing the need for better risk-based individualized strategies. When bacterial infections occur, the efficacy of antimicrobial therapies depends heavily on local epidemiological patterns and individual patient risk factors, necessitating tailored antibiotic selection based on regional resistance data and specific clinical scenarios. Nosocomial infections, colonization with multidrug-resistant organisms, and prior exposure to systemic antibiotics are key risk factors that should guide empirical therapy selection. Until evidence-based algorithms are available, clinicians should continue to adopt individualized approaches, guided by available evidence, local specificities, and antimicrobial stewardship principles to optimize patient outcomes.
Collapse
Affiliation(s)
- Frederic Haedge
- Department of Internal Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Tony Bruns
- Department of Internal Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| |
Collapse
|
|
2
|
Echefu G, Mahat R, Katragadda S, Reddy K. Sphingobacterium Spritivorum Associated With Spontaneous Bacterial Peritonitis in a Cirrhotic Patient With Gram-Positive Bacteremia. Cureus 2022; 14:e26053. [PMID: 35865420 PMCID: PMC9289197 DOI: 10.7759/cureus.26053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 11/05/2022] Open
Abstract
Sphingobacterium spritivorum (SS) is a ubiquitous gram-negative organism and an uncommon cause of infection in humans. To our knowledge, there are no reported cases of this bacterium causing spontaneous bacterial peritonitis (SBP) in patients with cirrhosis. In this report, we discuss a case of a male patient in his late 60s who presented with severe sepsis from methicillin-resistant staphylococcus aureus (MRSA), in whom SS was subsequently identified via ascitic fluid culture. This unusual organism is known to have an innate resistance to multiple antibiotics and can cause life-threatening sepsis in cases of delayed or missed diagnosis. Clinicians should not be weighed down by anchoring bias and look for alternative, uncommon gram-negative organisms in cases of progressive sepsis in patients with ascites.
Collapse
|
|
3
|
Kamila S, Gurunath S, Srinivas N, Babu S, Abhiman G, Ushasri R, Taha S, Salunke S, Komittishetty S. Efficacy and Pattern of Antibiotic Usage Among Patients with Cirrhosis and/or Chronic Liver Disease in Telangana, India. EXPLORATORY RESEARCH AND HYPOTHESIS IN MEDICINE 2020; 000:1-6. [DOI: 10.14218/erhm.2020.00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
|
4
|
Ghafar AA, Rozaik S, Akef A. Rifaximin plus norfloxacin versus norfloxacin alone in primary prophylaxis of spontaneous bacterial peritonitis in patients with variceal bleeding. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2019. [DOI: 10.4103/ejim.ejim_6_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
|
5
|
Duah A, Nkrumah KN. Spontaneous bacterial peritonitis among adult patients with ascites attending Korle-Bu Teaching Hospital. Ghana Med J 2019; 53:37-43. [PMID: 31138942 PMCID: PMC6527825 DOI: 10.4314/gmj.v53i1.6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Spontaneous bacterial peritonitis (SBP) is one of the most common and life-threatening complications of ascites, mostly in patients with cirrhotic ascites and children with nephrotic syndrome. Recognition and prompt treatment of this condition is essential to prevent serious morbidity and mortality. It is therefore important to determine the prevalence of SBP among in-patients with ascites attending our facility and to determine the clinical characteristics associated with SBP among these patients. Methods A cross-sectional study was conducted involving 140 patients with ascites irrespective of the underlying cause from 25th March 2016 to 25th November 2016. Demographic information and clinical data were collected using a standardized questionnaire. Ascitic fluid culture, the gold standard for SBP diagnosis and ascitic fluid cell count was done. Positive ascitic fluid culture and/ or ascitic polymorpho nuclear leukocyte ≥250cells/mm3 were diagnostic for SBP. Results Of the 140 patients with ascites the mean age was 44.7±13.2 years. There were seventy six (76) male and sixty four (64) female patients. The prevalence of SBP was 21.43% (30/140). Majority, (41.7%) of the bacteria isolated from ascitic fluid with SBP was Escherichia coli. History of jaundice, low arterial blood pressure on admission and encephalopathy were found to be independent predictors of SBP. Conclusion SBP is common among patients with ascites admitted at the Korle-Bu Teaching Hospital. Jaundice, encephalopathy and low blood pressure are highly suggestive of SBP and diagnostic paracentesis should be done immediately on admission to confirm the diagnosis. Funding None.
Collapse
Affiliation(s)
- Amoako Duah
- Department of Medicine, St. Dominic Hospital, P.O. Box 59, Akwatia, Ghana
| | - Kofi N Nkrumah
- Department of Medicine nd Therapeutics, School of Medicine and Dentistry, College Of Health Science, University Of Ghana, P.O. Box 4236, Korle-Bu, Accra, Ghana
| |
Collapse
|
|
6
|
Ghobrial C, Mogahed EA, El-Karaksy H. Routine analysis of ascitic fluid for evidence of infection in children with chronic liver disease: Is it mandatory? PLoS One 2018; 13:e0203808. [PMID: 30289914 PMCID: PMC6173381 DOI: 10.1371/journal.pone.0203808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 08/28/2018] [Indexed: 11/18/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Carolyne Ghobrial
- Pediatric Hepatology Unit, Pediatrics Department, Kasr Alainy School of Medicine, Cairo, Egypt
| | - Engy Adel Mogahed
- Pediatric Hepatology Unit, Pediatrics Department, Kasr Alainy School of Medicine, Cairo, Egypt
| | - Hanaa El-Karaksy
- Pediatric Hepatology Unit, Pediatrics Department, Kasr Alainy School of Medicine, Cairo, Egypt
| |
Collapse
|
|
7
|
Mousa N, Besheer T, Abdel-Razik A, Hamed M, Deiab AG, Sheta T, Eldars W. Can combined blood neutrophil to lymphocyte ratio and C-reactive protein be used for diagnosis of spontaneous bacterial peritonitis? Br J Biomed Sci 2018; 75:71-75. [PMID: 29452544 DOI: 10.1080/09674845.2017.1396706] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Spontaneous bacterial peritonitis (SBP) is diagnosed by the presence of ≥250 polymorphonuclear neutrophils (PMN)/mm3 in the ascites and the absence of surgically treatable cause of intra-abdominal infection. Blood neutrophil lymphocytic ratio (NLR) is an inexpensive and simple test for inflammation. C-reactive protein (CRP) is an inflammatory marker used for the diagnosis and follow-up of many diseases and morbidities. We aimed to evaluate the clinical utility of combined blood NLR and CRP as a non-invasive test for SBP diagnosis. METHODS Blood NLR was calculated, and CRP value determined in 180 cirrhotic patients with ascites (126 with and 54 without SBP). Sensitivity and specificity of combined blood NLR and CRP values for SBP diagnosis were estimated by receiver operator characteristic curve. RESULTS Both blood NLR and CRP values were significantly higher in SBP (p < 0.001). For SBP diagnosis, a blood NLR of >2.89 had a sensitivity 80.3% and specificity 88.9%. CRP >11.3 mg/dL had a sensitivity 88.9% and specificity 92.6%. In logistic regression analysis, combined blood NLR and CRP had a sensitivity 95.1% and specificity 96.3% at the same cut off values. CONCLUSIONS Combined NLR and CRP could be used as a novel, simple, low-cost, non-invasive test for SBP diagnosis.
Collapse
Affiliation(s)
- N Mousa
- a Tropical Medicine Department , Mansoura University , Mansoura , Egypt
| | - T Besheer
- a Tropical Medicine Department , Mansoura University , Mansoura , Egypt
| | - A Abdel-Razik
- a Tropical Medicine Department , Mansoura University , Mansoura , Egypt
| | - M Hamed
- b Internal Medicine Department , Mansoura University , Mansoura , Egypt
| | - A G Deiab
- b Internal Medicine Department , Mansoura University , Mansoura , Egypt
| | - T Sheta
- b Internal Medicine Department , Mansoura University , Mansoura , Egypt
| | - W Eldars
- c Faculty of Medicine, Medical Microbiology and Immunology Department , Mansoura University , Mansoura , Egypt
| |
Collapse
|
|
8
|
Hepatic Failure. PRINCIPLES OF ADULT SURGICAL CRITICAL CARE 2016. [PMCID: PMC7123541 DOI: 10.1007/978-3-319-33341-0_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The progression of liver disease can cause several physiologic derangements that may precipitate hepatic failure and require admission to an intensive care unit. The underlying pathology may be acute, acute-on chronic, or chronic in nature. Liver failure may manifest with a variety of clinical signs and symptoms that need prompt attention. The compromised synthetic and metabolic activity of the failing liver affects all organ systems, from neurologic to integumentary. Supportive care and specific therapies should be instituted in order to improve outcome and minimize time of recovery. In this chapter we will discuss the definition, clinical manifestations, workup, and management of acute and chronic liver failure and the general principles of treatment of these patients. Management of liver failure secondary to certain common etiologies will also be presented. Finally, liver transplantation and alternative therapies will also be discussed.
Collapse
|
|
9
|
Asadabadi L, Heyran MM, Mirafzal A. Identifying high and low serum-ascites albumin gradient in ascitic fluid by the point of care dipstick test. JOURNAL OF EMERGENCY PRACTICE AND TRAUMA 2015. [DOI: 10.15171/jept.2015.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
|
10
|
Understanding the Complexities of Cirrhosis. Clin Ther 2015; 37:1822-36. [DOI: 10.1016/j.clinthera.2015.05.507] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/25/2015] [Accepted: 05/08/2015] [Indexed: 12/13/2022]
|
|
11
|
Honar N, Geramizadeh B, Dehghani SM, Kalvandi G, Shahramian I, Rahmani A, Javaherizadeh H. EVALUATION OF LEUKOCYTE ESTERASE REAGENT STRIPS TEST IN THE DIAGNOSIS OF SPONTANEOUS BACTERIAL PERITONITIS IN CHILDREN WITH CIRRHOSIS. ARQUIVOS DE GASTROENTEROLOGIA 2015; 52:195-199. [PMID: 26486286 DOI: 10.1590/s0004-28032015000300008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/27/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Spontaneous bacterial peritonitis is defined as an ascetic fluid infection without an evident intra-abdominal surgically treatable source. Spontaneous bacterial peritonitis is one of the severe complications in patients with cirrhosis and ascites. Without early antibiotic treatment, this complication is associated with high mortality rate; therefore, early diagnosis and treatment of spontaneous bacterial peritonitis is necessary for survival. Leukocyte esterase reagent can rapidly diagnose the spontaneous bacterial peritonitis. OBJECTIVE This study aimed to find out the diagnostic accuracy of leukocyte esterase dipstick test for the diagnosis of spontaneous bacterial peritonitis. METHODS A single centered hospital-based cross-sectional study was conducted during July 2013 to August 2014 on children with cirrhotic liver disease and ascites who were admitted in the Department of Pediatric Gastroenterology in Nemazee Hospital affiliated to Shiraz University of Medical Sciences (Iran). All patients underwent abdominal paracentesis, and the ascitic fluid was processed for cell count, leukocyte esterase reagent strip test (Combiscreen SL10) and culture. Spontaneous bacterial peritonitis was defined as having a polymorphonuclear count (PMN ≥250/m3) in ascitic fluid. Sensitivity, specificity, positive predictive value and negative predictive value of leukocyte esterase test were calculated according to the formula. RESULTS Totally, 150 ascitic fluid sample of cirrhotic male patients (53.2%) and their mean age (4.33±1.88 years) were analyzed. Biliary atresia (n=44, 29.4%) and idiopathic neonatal hepatitis (n=29, 19.3%) were the most frequent etiology of cirrhosis. Also, abdominal pain (68.6%) and distension (64%) were the most common presenting complaint. Of all cases, 41 patients (27.35%) were diagnosed to have spontaneous bacterial peritonitis (PMN ≥250/mm3). Sensitivity and specificity of leukocyte esterase reagent test according to PMNs ≥250 mm3 were 87.80% and 91.74%, also on ascitic fluid culture results were 88.23% and 77.44%. Positive predictive value and negative predictive value of this test in PMNs ≥250 mm3 were 80% and 95.23% and in cases with positive culture 33.33% and 98.09% were obtained, respectively. Efficiency of leukocyte esterase reagent test in diagnosing spontaneous bacterial peritonitis, according to PMNs ≥250 mm3 and culture results were 90.66% and 78.66%. CONCLUSION The leukocyte esterase strip test may be used as rapid test for diagnosis of spontaneous bacterial peritonitis due to its high diagnostic validity.
Collapse
Affiliation(s)
- Naser Honar
- Gastroenterohepatology Research Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Fars, IR
| | - Bita Geramizadeh
- Gastroenterohepatology Research Center|Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Fars, IR
| | - Seyed-Mohsen Dehghani
- Gastroenterohepatology Research Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Fars, IR
| | - Gholamreza Kalvandi
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, IR
| | - Iraj Shahramian
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, IR
| | - Asghar Rahmani
- Student Research committee, School of medicine, Ilam University of Medical Sciences, Ilam, Ilam, IR
| | - Hazhir Javaherizadeh
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, IR
| |
Collapse
|
|
12
|
Ahmed AMM, Kadaru AGY, Omer I, Musa AM, Enan K, El Khidir IM, Williams R. Macrophages from patients with cirrhotic ascites showed function alteration of host defense receptor. J Clin Exp Hepatol 2014; 4:279-86. [PMID: 25755574 PMCID: PMC4298631 DOI: 10.1016/j.jceh.2014.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 08/15/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with cirrhotic ascites (PCA) are susceptible to spontaneous bacterial peritonitis (SBP) which has increased morbidity and mortality. Since some host defense aspects of peritoneal macrophages (PMф) from PCA are altered this study examined factors related to receptor-mediated phagocytosis. METHODS Twelve PCA were studied. PMɸ were isolated from ascitic fluid (AF) samples removed from these patients. Uptake of mannose receptor (MR)-specific ligand, fluorescein isothiocyanate-mannosylated-bovine serum albumin (FITC-man-BSA), by patients' PMɸ and controls, a human monocytic cell line, was measured pre- and post-IL-4 treatment. Phagocytosis of FITC-labeled yeast particles by patients' PMɸ was measured pre- and post-IL-4 treatment. Fluorescence values were obtained using a spectrofuorometer. MRC1 gene was analyzed in blood samples from PCA and controls, healthy donors, using standard polymerase chain reaction (PCR) technique. RESULTS Past SBP episode(s) were reported in 58.3% of patients. Mean AF volume analyzed per patient was 1.3L. PMɸ ratio in cell yield was 53.73% (SD 18.1). Mean uptake absorbance of patients' PMф was 0.0841 (SD 0.077) compared to 0.338 (SD 0.34) of controls, P = 0.023. Following IL-4 treatment absorbance increased to 0.297 (SD 0.28) in patients' PMф (P = 0.018 on paired sample t-test), and to 0.532 (SD 0.398 in controls (P = 0.053 on independent sample t-test). Mean phagocytosis absorbance of patients' PMф was 0.1250 (SD 0.032) before IL-4 treatment compared to 0.2300 (SD 0.104) after (P = 0.026). PCR analysis for MRC1 gene was negative in all PCA samples compared to positive results in all controls. CONCLUSION Since decreased phagocytosis and MR uptake were enhanced post-IL-4 treatment MR downregulation pre-treatment is plausible. Negative PCR results for MRC1 might suggest an anomaly, but this awaits further ellucidation. These altered host defense findings are relevant to infection pathophysiology, and their relevance to SBP susceptibility in PCA is worth verifying.
Collapse
Key Words
- AF, ascitic fluid
- FBS, foetal bovine serum
- FITC, fluorescein isothiocyanate
- IL-4, interleukin-4
- MR, mannose receptor
- MRC1 gene
- MRC1, gene encoding human MR
- PCA, patients with cirrhotic ascites
- PCR, polymerase chain reaction
- PMф, peritoneal macrophages
- RPMI and DMEM, cell culture media
- cirrhosis
- macrophage host defense
- man-BSA, mannosylated bovine serum albumin
- mannose receptor
- spontaneous bacterial peritonitis
Collapse
Affiliation(s)
- Abdel Motaal M. Ahmed
- Department of Medicine, The National University for Medical and Allied Sciences, Khartoum 11123, Sudan
- Address for correspondence: Abdel Motaal M. Ahmed, Consultant Gastroenterologist and Associate Professor, Department of Medicine, The National University for Medical and Allied Sciences, Khartoum 11123, Sudan. Tel.: +249 114624484 (mobile); fax: +249 183789554.
| | - Abdel Gadir Y. Kadaru
- Department of Medicine, Faculty of Medicine, University of Khartoum, Khartoum 11123, Sudan
| | - Ibtihal Omer
- Microbiology Department, Ribat University, Khartoum 11123, Sudan
| | - Ahmed M. Musa
- Institute of Endemic Diseases, University of Khartoum, Khartoum 11123, Sudan
| | - Khalid Enan
- Molecular Biology Unit, The National Research Laboratory Centre, Khartoum 11123, Sudan
| | - Isam M. El Khidir
- Virology Department, Faculty of Medicine, University of Khartoum, Khartoum 11123, Sudan
| | - Roger Williams
- Institute of Hepatology, The Foundation for Liver Research, London, UK
| |
Collapse
|
|
13
|
Topdagi O, Okcu N, Bilen N. The frequency of complications and the etiology of disease in patients with liver cirrhosis in erzurum. Eurasian J Med 2014; 46:110-4. [PMID: 25610308 PMCID: PMC4261449 DOI: 10.5152/eajm.2014.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 08/31/2013] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE This study included 100 patients diagnosed with liver cirrhosis who presented at Atatürk University Faculty of Medicine Gastroenterology clinic and polyclinic. MATERIALS AND METHODS The etiology of liver cirrhosis and the incidence of its complications have been investigated. RESULTS The etiological classification of liver cirrhosis in our patients was as follows: 47 hepatitis B virus hepatitis, 11 hepatitis C virus hepatitis, 5 HBV+HDV hepatitis, 4 Budd Chiari syndrome, 2 chronic alcohol abuse, 2 ischemic heart disease, 1 autoimmune hepatitis, 1 sclerosing cholangitis, 1 hydatid cyst. In 26 patients we could not find any etiological condition. These patients were called cryptogenic cirrhosis patients.When we examined the complications of liver cirrhosis, it appeared that there were ascites in 83 patient. In 56 patients, esophageal variceal bleeding occurred. There was spontaneous bacterial peritonitis in 42 patients. Hepatorenal syndrome occurred in 26 patients. Finally, in 3 patients we detected hepatorenal syndrome. CONCLUSION The most common causes in the etiology of liver cirrhosis are viral, especially HBV. Many of the patients were in decompensated phase when diagnosed. We found that there was a close relation between the frequency of complications and mortality in liver cirrhosis.
Collapse
Affiliation(s)
- Omer Topdagi
- Department of Internal Medicine, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Nihat Okcu
- Department of Internal Medicine, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Nurhan Bilen
- Department of Internal Medicine, Ataturk University Faculty of Medicine, Erzurum, Turkey
| |
Collapse
|
|
14
|
Lippi G, Danese E, Cervellin G, Montagnana M. Laboratory diagnostics of spontaneous bacterial peritonitis. Clin Chim Acta 2014; 430:164-70. [PMID: 24508989 DOI: 10.1016/j.cca.2014.01.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 01/09/2014] [Accepted: 01/11/2014] [Indexed: 12/13/2022]
Abstract
The term peritonitis indicates an inflammatory process involving the peritoneum that is most frequently infectious in nature. Primary or spontaneous bacterial peritonitis (SBP) typically occurs when a bacterial infection spreads to the peritoneum across the gut wall or mesenteric lymphatics or, less frequently, from hematogenous transmission in combination with impaired immune system and in absence of an identified intra-abdominal source of infection or malignancy. The clinical presentation of SBP is variable. The condition may manifest as a relatively insidious colonization, without signs and symptoms, or may suddenly occur as a septic syndrome. Laboratory diagnostics play a pivotal role for timely and appropriate management of patients with bacterial peritonitis. It is now clearly established that polymorphonuclear leukocyte (PMN) in peritoneal fluid is the mainstay for the diagnosis, whereas the role of additional biochemical tests is rather controversial. Recent evidence also suggests that automatic cell counting in peritoneal fluid may be a reliable approach for early screening of patients. According to available clinical and laboratory data, we have developed a tentative algorithm for efficient diagnosis of SBP, which is based on a reasonable integration between optimization of human/economical resources and gradually increasing use of invasive and expensive testing. The proposed strategy entails, in sequential steps, serum procalcitonin testing, automated cell count in peritoneal fluid, manual cell count in peritoneal fluid, peritoneal fluid culture and bacterial DNA testing in peritoneal fluid.
Collapse
Affiliation(s)
- Giuseppe Lippi
- Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma, Parma, Italy.
| | - Elisa Danese
- Laboratory of Clinical Chemistry and Hematology, University of Verona, Verona, Italy
| | | | - Martina Montagnana
- Laboratory of Clinical Chemistry and Hematology, University of Verona, Verona, Italy
| |
Collapse
|
|
15
|
Oladimeji AA, Temi AP, Adekunle AE, Taiwo RH, Ayokunle DS. Prevalence of spontaneous bacterial peritonitis in liver cirrhosis with ascites. Pan Afr Med J 2013; 15:128. [PMID: 24255734 PMCID: PMC3830462 DOI: 10.11604/pamj.2013.15.128.2702] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 07/19/2013] [Indexed: 12/11/2022] Open
Abstract
Introduction Spontaneous bacterial peritonitis (SBP) is a common bacterial infection in patients with cirrhosis and ascites requiring prompt recognition and treatment. The aim of this study was to determine the prevalence, and characteristics of SBP among in-patients with cirrhosis and ascites seen at our facility. Methods Thirty one patients with liver cirrhosis and ascites who were admitted into the Medical ward of the Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Nigeria from August 2009 to July 2010 were retrospectively studied. All the patients had abdominal paracentesis done within 48 hours of admission under aseptic condition and the data obtained were analyzed. Results The mean age of the studied population was 62±9 years (age range 43-78 years). Of the 21 that developed SPB, culture positive SBP was present in 66.7% (14/21) while CNNA was found in 33.3% (7/21). The prevalence of MNB was 26% (8/31) in this study. Of those with SBP, 93% had monomicrobial infection with aerobic Gram negative bacilli being responsible in 66.7% of the cases with E.coli (70%) being the predominant organism followed by Klebsiella species. Gram positive organisms accounted for 33.3% with Streptococcal species (60%) being the predominant organism followed by Staphylococcus aureus (40%). Patients with SBP had significantly lower platelet count when compared with those without SBP, p < 0.05. Also, international normalization ratio (INR) was significantly higher in those patients with SBP compared with those without SBP, p < 0.05. The poor prognostic indicators found in this study were; low ascitic protein, hepatic encephalopathy, coagulopathy, renal dysfunction (creatinine >2mg/dl) and leukocytosis (p < 0.05). Conclusion It is therefore imperative to do diagnostic abdominal paracentesis for cell count and culture in any patient with onset of ascites or cirrhotic patients with ascites and suggestive symptoms compatible or suggestive of SBP.
Collapse
Affiliation(s)
- Ajayi Akande Oladimeji
- Department of Medicine, Ekiti State University Teaching Hospital, P.M.B 5355, Ado Ekiti, Nigeria
| | | | | | | | | |
Collapse
|
|
16
|
Heidari K, Amiri M, Kariman H, Bassiri M, Alimohammadi H, Hatamabadi HR. Differentiation of exudate from transudate ascites based on the dipstick values of protein, glucose, and pH. Am J Emerg Med 2013; 31:779-82. [DOI: 10.1016/j.ajem.2013.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 01/12/2013] [Accepted: 01/13/2013] [Indexed: 02/08/2023] Open
|
|
17
|
Diagnostic value of lactoferrin ascitic fluid levels in spontaneous bacterial peritonitis. EGYPTIAN LIVER JOURNAL 2013. [DOI: 10.1097/01.elx.0000427108.01923.3d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
|
|
18
|
Spontaneous bacterial peritonitis due to streptococcus pneumoniae--case report. POLISH JOURNAL OF SURGERY 2012; 83:283-6. [PMID: 22166482 DOI: 10.2478/v10035-011-0044-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Spontaneous bacterial peritonitis is caused by infection of ascitic fluid without any apparent intraabdominal source of infection. The disease most commonly occurs in patients with cirrhosis and 70% of cases of infections are caused by pathogenes from gastrointestinal tract. The article presents the case of 38-year-old patient with spontaneous peritonitis who was treated surgically. The primary nature of the disease was confirmed by laparotomy and bacteriological examination results (Streptoccocus pneumonia) of ascitic fluid. After 54 days of hospitalisation and undergoing re-laparotomy, he was discharged in good condition.
Collapse
|
|
19
|
Mahajan R, Matreja PS, Singh Gill A, Singh Chinna R, Kaur Chhina D. Spontaneous Bacterial Peritonitis in Alcoholic Cirrhosis: An Indian Perspective. Euroasian J Hepatogastroenterol 2012. [DOI: 10.5005/jp-journals-10018-1024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
|
|
20
|
Leukocyte esterase dipstick in diagnosis and follow-up of spontaneous bacterial peritonitis. EGYPTIAN LIVER JOURNAL 2011. [DOI: 10.1097/01.elx.0000403699.64907.5e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
|
21
|
Camins BC, Marschall J, DeVader SR, Maker DE, Hoffman MW, Fraser VJ. The clinical impact of fluoroquinolone resistance in patients with E coli bacteremia. J Hosp Med 2011; 6:344-9. [PMID: 21834116 PMCID: PMC3156036 DOI: 10.1002/jhm.877] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are limited data on fluoroquinolone resistance and its impact on mortality in cases of Escherichia coli bloodstream infection (BSI). OBJECTIVE To determine risk factors for in-hospital mortality among patients with E coli BSIs. DESIGN A retrospective case-control study. SETTING A 1250-bed tertiary academic medical center. PATIENTS Patients with fluoroquinolone-resistant E coli BSI from January 1, 2000 through December 31, 2005 with 1:1 matched control patients with fluoroquinolone-sensitive E coli BSI. INDEPENDENT OUTCOME: In-hospital mortality. RESULTS A total of 93 cases and 93 control patients were included. Compared with control patients, cases were more likely to be admitted from a long-term care facility (35% vs. 9%; P < .001) and to have a hospital-acquired bacteremia (54% vs. 33%; P = .008). Crude mortality was 26% for cases and 8% for controls (P = .002). On univariate analysis, predictors for in-hospital mortality included female gender, admission from a long-term care facility, APACHE II score >10, Charlson comorbidity score >4, cardiac dysfunction, cirrhosis, renal dysfunction, treatment with corticosteroids, and a fluoroquinolone-resistant E coli bacteremia. On multivariate analysis, independent risk factors for in-hospital mortality were cirrhosis (adjusted odds ratio [aOR], 7.2; confidence interval [CI], 1.7-29.8; P = .007), cardiac dysfunction (aOR, 3.9; CI, 1.6-9.4; P = .003), and infection with a fluoroquinolone-resistant E coli isolate (aOR, 3.9; CI, 1.5-10.2; P = .005). CONCLUSIONS After controlling for severity of illness and multiple comorbidities only fluoroquinolone resistance, cirrhosis, and cardiac dysfunction independently predicted mortality in patients with E coli bacteremia.
Collapse
Affiliation(s)
- Bernard C Camins
- Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri 63110-1093, USA.
| | | | | | | | | | | |
Collapse
|
|
22
|
Etiology of spontaneous bacterial peritonitis and determination of their antibiotic susceptibility patterns in Iran. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2011. [DOI: 10.1016/s2222-1808(11)60049-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
|
23
|
Abstract
The pediatric population has a number of unique considerations related to the diagnosis and treatment of ascites. This review summarizes the physiologic mechanisms for cirrhotic and noncirrhotic ascites and provides a comprehensive list of reported etiologies stratified by the patient's age. Characteristic findings on physical examination, diagnostic imaging, and abdominal paracentesis are also reviewed, with particular attention to those aspects that are unique to children. Medical and surgical treatments of ascites are discussed. Both prompt diagnosis and appropriate management of ascites are required to avoid associated morbidity and mortality.
Collapse
|
|
24
|
Jung SK, Lee JS, Kim KA, Kim YD, Jwa YJ, Kim NK, Kwak YG. Spontaneous Bacterial Peritonitis Caused byHafnia alveiin a Patient with Liver Cirrhosis. Infect Chemother 2010. [DOI: 10.3947/ic.2010.42.6.420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sang Kyung Jung
- Department of Internal Medicine, Inje University College of Medicine, Goyang, Korea
| | - June Sung Lee
- Department of Internal Medicine, Inje University College of Medicine, Goyang, Korea
| | - Kyung Ah Kim
- Department of Internal Medicine, Inje University College of Medicine, Goyang, Korea
| | - Young Doo Kim
- Department of Internal Medicine, Inje University College of Medicine, Goyang, Korea
| | - Yoon Jung Jwa
- Department of Internal Medicine, Inje University College of Medicine, Goyang, Korea
| | - Na Kyung Kim
- Department of Internal Medicine, Inje University College of Medicine, Goyang, Korea
| | - Yee Gyung Kwak
- Department of Internal Medicine, Inje University College of Medicine, Goyang, Korea
| |
Collapse
|
|
25
|
Sharma PK, Engels E, Van Oeveren W, Ploeg RJ, van Henny der Mei C, Busscher HJ, Van Dam GM, Rakhorst G. Spatiotemporal progression of localized bacterial peritonitis before and after open abdomen lavage monitored by in vivo bioluminescent imaging. Surgery 2009; 147:89-97. [PMID: 19733882 DOI: 10.1016/j.surg.2009.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Accepted: 05/21/2009] [Indexed: 01/13/2023]
Abstract
BACKGROUND Bacterial peritonitis is a life-threatening abdominal infection associated with high morbidity and mortality. The rat is a popular animal model for studying peritonitis and its treatment, but longitudinal monitoring of the progression of peritonitis in live animals has been impossible until now and thus required a large number of animals. Our objective was to develop a noninvasive in vivo imaging technique to monitor the spatiotemporal spread of bacterial peritonitis. METHODS Peritonitis was induced in 8 immunocompetent male Wistar rats by placing fibrin clots containing 5x10(8) cells of both Bacteroides fragilis (American Type Tissue Culture [ATCC)] 25,285 and bioluminescent Escherichia coli Xen14. After 1 or 2 days, infected clots were removed and open abdomen lavage was performed. In vivo bioluminescent imaging was used to monitor the spread of peritonitis. RESULTS Bioluminescent in vivo imaging showed an increase in the area of spread, and the number of E. coli tripled into the rat's abdominal cavity on day 1 after clot insertion; however, on day 2, encapsulation of the clot confined bacterial spread. Bioluminescent E. coli respread over the peritoneal cavity after lavage; within 10 days, however, in vivo imaging showed a decrease of 3-4 orders of magnitude in bacterial load. CONCLUSION Bioluminescent in vivo imaging can be effectively used to monitor the spatiotemporal behavior of the peritonitis during 3 different stages of the disease process: initiation, treatment, and follow-up. Imaging allows researchers to repeatedly image the same animal, thereby reducing variability and providing greater confidence in determining treatment efficacies for therapeutic interventions using a small number of animals.
Collapse
Affiliation(s)
- Prashant K Sharma
- Department of Biomedical Engineering, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
|
26
|
Wilkerson RG, Sinert R. The Use of Paracentesis in the Assessment of the Patient With Ascites. Ann Emerg Med 2009; 54:465-8. [DOI: 10.1016/j.annemergmed.2008.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Revised: 09/10/2008] [Accepted: 09/10/2008] [Indexed: 10/21/2022]
|
|
27
|
Chinnock B, Fox C, Hendey GW. Gram's Stain of Peritoneal Fluid Is Rarely Helpful in the Evaluation of the Ascites Patient. Ann Emerg Med 2009; 54:78-82. [DOI: 10.1016/j.annemergmed.2008.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Revised: 11/21/2008] [Accepted: 12/16/2008] [Indexed: 11/17/2022]
|
|
28
|
Torun S, Dolar E, Yilmaz Y, Keskin M, Kiyici M, Sinirtas M, Sarandol E, Gurel S, Nak SG, Gulten M. Evaluation of leukocyte esterase and nitrite strip tests to detect spontaneous bacterial peritonitis in cirrhotic patients. World J Gastroenterol 2008; 13:6027-30. [PMID: 18023094 PMCID: PMC4250885 DOI: 10.3748/wjg.v13.45.6027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the diagnostic efficacy of leukocyte esterase and nitrite reagent strips for bedside diagnosis of spontaneous bacterial peritonitis (SBP). METHODS A total of 63 consecutive patients with cirrhotic ascites (38 male, 25 female) tested between April 2005 and July 2006 were included in the study. Bedside reagent strip testing was performed on ascitic fluid and the results compared to manual cell counting and ascitic fluid culture. SBP was defined as having a polymorphonuclear ascites count of >or= 250/mm(3). RESULTS Fifteen samples showed SBP. The sensitivity, specificity, positive and negative predictive values of the leukocyte esterase reagent strips were; 93%, 100%, 100%, and 98%, respectively. The sensitivity, specificity, positive and negative predictive value of the nitrite reagent strips were 13%, 93%, 40%, and 77%, respectively. The combination of leukocyte esterase and nitrite reagents strips did not yield statistically significant effects on diagnostic accuracy. CONCLUSION Leukocyte esterase reagent strips may provide a rapid, bedside diagnostic test for SBP.
Collapse
Affiliation(s)
- Serkan Torun
- Uludag University Medical School, Department of Internal Medicine, Bursa 16059, Turkey
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
29
|
Torun S, Dolar E, Yilmaz Y, Keskin M, Kiyici M, Sinirtas M, Sarandol E, Gurel S, Nak SG, Gulten M. Evaluation of leukocyte esterase and nitrite strip tests to detect spontaneous bacterial peritonitis in cirrhotic patients. World J Gastroenterol 2008. [PMID: 18023094 DOI: 10.3748/wjg.13.6027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the diagnostic efficacy of leukocyte esterase and nitrite reagent strips for bedside diagnosis of spontaneous bacterial peritonitis (SBP). METHODS A total of 63 consecutive patients with cirrhotic ascites (38 male, 25 female) tested between April 2005 and July 2006 were included in the study. Bedside reagent strip testing was performed on ascitic fluid and the results compared to manual cell counting and ascitic fluid culture. SBP was defined as having a polymorphonuclear ascites count of >or= 250/mm(3). RESULTS Fifteen samples showed SBP. The sensitivity, specificity, positive and negative predictive values of the leukocyte esterase reagent strips were; 93%, 100%, 100%, and 98%, respectively. The sensitivity, specificity, positive and negative predictive value of the nitrite reagent strips were 13%, 93%, 40%, and 77%, respectively. The combination of leukocyte esterase and nitrite reagents strips did not yield statistically significant effects on diagnostic accuracy. CONCLUSION Leukocyte esterase reagent strips may provide a rapid, bedside diagnostic test for SBP.
Collapse
Affiliation(s)
- Serkan Torun
- Uludag University Medical School, Department of Internal Medicine, Bursa 16059, Turkey
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
30
|
Affiliation(s)
- Benjamin L Shneider
- Department of Pediatrics, Thomas E. Starzl Transplantation Institute, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
| | | |
Collapse
|
|
31
|
Chinnock B, Hendey GW. Can clear ascitic fluid appearance rule out spontaneous bacterial peritonitis? Am J Emerg Med 2007; 25:934-7. [PMID: 17920980 DOI: 10.1016/j.ajem.2007.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Revised: 01/27/2007] [Accepted: 02/04/2007] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE The objective of the study was to determine the sensitivity and specificity of abnormal ascitic fluid appearance in the detection of spontaneous bacterial peritonitis (SBP), as a sensitivity approaching 100% could exclude SBP if the fluid is clear. METHODS We performed a retrospective review of all ascitic fluid samples sent for cell count over a 4-year period. Spontaneous bacterial peritonitis was defined as an absolute neutrophil count of more than 250 cells/mm3 or a positive culture. Abnormal fluid appearance was defined as hazy, cloudy, or bloody. RESULTS There were 916 ascitic fluid samples analyzed during the study period. Eighteen percent of samples had a clear appearance, whereas 82% were abnormal. Abnormal ascitic fluid appearance had a sensitivity of 98.1% (95% confidence interval, 95.3%-99.5%) and a specificity of 22.7% (95% confidence interval, 19.4%-26.3%) in the detection of SBP. CONCLUSIONS Abnormal fluid appearance has a high sensitivity for the detection of SBP. Thus, clear fluid might safely exclude SBP.
Collapse
Affiliation(s)
- Brian Chinnock
- Department of Emergency Medicine, UCSF-Fresno Medical Education Program, Community Regional Medical Center, Fresno, CA 93701, USA.
| | | |
Collapse
|
|
32
|
Abstract
Bacterial infections are well described complications of cirrhosis that greatly increase mortality rates. Two factors play important roles in the development of bacterial infections in these patients: the severity of liver disease and gastrointestinal haemorrhage. The most common infections are spontaneous bacterial peritonitis, urinary tract infections, pneumonia and sepsis. Gram-negative and gram-positive bacteria are equal causative organisms. For primary prophylaxis, short-term antibiotic treatment (oral norfloxacin or ciprofloxacin) is indicated in cirrhotic patients (with or without ascites) admitted with gastrointestinal haemorrhage (variceal or non-variceal). Administration of norfloxacin is advisable for hospitalized patients with low ascitic protein even without gastrointestinal haemorrhage. The first choice in empirical treatment of spontaneous bacterial peritonitis is the iv. III. generation cephalosporin; which can be switched for a targeted antibiotic regime based on the result of the culture. The duration of therapy is 5-8 days. Amoxicillin/clavulanic acid and fluoroquinolones--patients not on prior quinolone prophylaxis--were shown to be as effective and safe as cefotaxime. In patients with evidence of improvement, iv. antibiotics can be switched safely to oral antibiotics after 2 days. In case of renal dysfunction, iv albumin should also be administered. Long-term antibiotic prophylaxis is recommended in patients who have recovered from an episode of spontaneous bacterial peritonitis (secondary prevention). For "selective intestinal decontamination", poorly absorbed oral norfloxacin is the preferred schedule. Oral ciprofloxacin or levofloxacin (added gram positive spectrum) all the more are reasonable alternatives. Trimethoprim/sulfamethoxazole is only for patients who are intolerant to quinolones. Prophylaxis is indefinite until disappearance of ascites, transplant or death. Long-term prophylaxis is currently not recommended for patients without previous spontaneous bacterial peritonitis episode, not even when refractory ascites or low ascites protein content is present.
Collapse
Affiliation(s)
- Mária Papp
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Altalános Orvostudományi Kar Belgyógyászati Intézet, Gasztroenterológiai Tanszék Debrecen Nagyerdei krt. 98. 4012, Hungary.
| | | | | | | |
Collapse
|
|
33
|
Abstract
This article presents a review of end-stage chronic liver disease (cirrhosis) with emphasis on the clinical presentation, diagnosis, and complications of cirrhosis, along with their medical and surgical management and prognosis. This article also discusses the evaluation and management of the dental patients with cirrhosis, including the implications decreased hepatic function has on drugs commonly used in dental treatment.
Collapse
Affiliation(s)
- F John Firriolo
- Division of Diagnostic Sciences, Department of Diagnostic Sciences, Prosthodontics and Restorative Dentistry, University of Louisville, School of Dentistry, 501 South Preston Street, Room E-32, Louisville, KY 40292, USA.
| |
Collapse
|
|
34
|
Kiyici M, Nak SG, Budak F, Gurel S, Oral B, Dolar E, Gulten M. Lymphocyte subsets and cytokines in ascitic fluid of decompensated cirrhotic patients with and without spontaneous ascites infection. J Gastroenterol Hepatol 2006; 21:963-9. [PMID: 16724979 DOI: 10.1111/j.1440-1746.2006.04229.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIM Spontaneous ascites infection is a frequently encountered and important complication of decompensated liver cirrhosis. The immune system plays an important role in the development or eradication of this infection. A number of compositional and functional alterations in immune system cells have been demonstrated in cirrhotic patients; however, there is a lack of knowledge about this issue in ascitic infections. The aim of the present study was to evaluate lymphocyte subsets and levels of some ascitic and lymphocytic intracytoplasmic cytokines in decompensated cirrhotic patients with or without spontaneous ascites infection. METHODS The study population consisted of 45 decompensated cirrhotic patients (32 men, 13 women) with different etiologies. Patients with ascitic polymorphonuclear leukocyte count > or =250/mm(3) and/or positive ascitic bacterial cultures were classified as the "infected group". Comparison was made between the infected and non-infected group for the following parameters: ascites leukocyte counts and differentiations; ascitic fluid protein; albumin levels and serum-ascites albumin gradients; flow cytometric detection of cell surface markers for ascitic T, B and natural killer lymphocytes; intracytoplasmic interleukin (IL)-2, IL-4, tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma; levels of ascitic IL-8, IL-10, IL-12 and TNF-alpha; and soluble Fas antigen and soluble Fas ligand. RESULTS The CD4/CD8 ratio was significantly decreased and expression of T cell receptor-gammadelta was increased in the infected group. Furthermore, ascites TNF-alpha levels were also elevated in this group. Ascitic IL-8, IL-10, IL-12 and TNF-alpha levels were significantly higher in patients with positive ascitic bacterial culture. CONCLUSIONS These results suggest that a cytotoxic, especially Th1, immune response predominates in ascites infections. It also demonstrates that TNF-alpha might be involved in the pathogenesis of ascites infections.
Collapse
Affiliation(s)
- Murat Kiyici
- Department of Gastroenterology, Medical Faculty, Uludag University, Bursa 16059, Turkey.
| | | | | | | | | | | | | |
Collapse
|
|
35
|
Frazee LA, Marinos AE, Rybarczyk AM, Fulton SA. Long-Term Prophylaxis of Spontaneous Bacterial Peritonitis in Patients with Cirrhosis. Ann Pharmacother 2005; 39:908-12. [PMID: 15769829 DOI: 10.1345/aph.1e585] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE: To review the literature regarding long-term prophylaxis of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis. DATA SOURCES: A MEDLINE (1967–September 2004) and bibliographic search of the English-language literature was conducted using the search terms spontaneous bacterial peritonitis, cirrhosis, antimicrobial, and prophylaxis. DATA SYNTHESIS: Long-term antimicrobial prophylaxis has been shown to decrease recurrent SBP in cirrhotics with a prior episode. Prophylaxis in patients with low ascitic fluid protein has also been shown to reduce the incidence of SBP; however, studies are too in-homogeneous to identify subgroups that benefit the most. CONCLUSIONS: Long-term antimicrobial therapy should be considered for secondary prophylaxis of SBP. Studies should be done to confirm this benefit and identify subsets of patients with low ascitic fluid protein who clearly benefit.
Collapse
|