Abstract
BackgroundSpontaneous bacterial peritonitis (SBP) and bacterascites (BA) represent frequent and serious complications in cirrhosis patients with ascites. However, few detailed data are available regarding the clinical and bacteriological feature of SBP or BA patients in China.MethodsWe retrospectively analyzed bacteriological and clinical characteristics of patients with SBP and BA at Beijing 302 Hospital in China from January 2012 to December 2015.ResultsA total of 600 patients with SBP (n = 408) or BA (n = 192) were enrolled. Patients with BA appeared to have a less severe clinical manifestation and lower mortality rate than patients with SBP. Gram-negative bacteria formed the majority of pathogens in SBP (73.9%) and BA (55.8%) cases. Higher ascitic fluid polymorphonuclear leucocytes (PMN) count and hepatocellular carcinoma were independent risk factors for BA episode progressing to SBP. The concentration of blood urea nitrogen (BUN) was independent risk factor for 30-day mortality of BA patients. For patients with SBP, the independent risk factors for 30-day mortality were age, Model for End-Stage Liver Disease (MELD) score, septic shock and hepatocellular carcinoma. Patients with third-generation cephalosporin or carbapenems resistant infection had a significantly lower survival probability. There were significant differences in clinical characteristics and outcome among the major bacteria. Multivariate analysis showed that patients infected with Klebsiella spp. had higher hazard ratio of 30-day mortality.ConclusionOur study reported the bacteriological and clinical characteristics of patients with SBP and BA. Higher ascitic fluid PMN count and hepatocellular carcinoma were found to be independent risk factors for BA episode progressed to SBP. Outcome of ascitic fluid infection in patients with cirrhosis was influenced by the type of bacteria and antimicrobial susceptibility.
Highlights
Spontaneous bacterial peritonitis (SBP) and bacterascites (BA) represent frequent and serious complications in cirrhosis patients with ascites
Consistent with previous studies, we found that Model for End-Stage Liver Disease (MELD) score [22], the presentation of hepatocellular carcinoma [23] and presentation of septic shock [19] were independent risk factors for 30-day mortality at the time of SBP diagnosis
Presentation of hepatocellular carcinoma and higher ascitic polymorphonuclear leucocytes (PMN) count were independent risk factors for BA progressing to SBP
Summary
Spontaneous bacterial peritonitis (SBP) and bacterascites (BA) represent frequent and serious complications in cirrhosis patients with ascites. Previous studies showed that gram-negative bacteria, mainly Enterobacteriaceae, were major causative organisms of ascitic fluid infection [3, 4]. Third generation cephalosporins are the first line antibiotics to treat spontaneous bacterial peritonitis; it was showed that the initial treatment with cefotaxime, one of the most commonly used cephalosporins, failed more frequently than expected [5]. It may be explained by the change of causative pathogen profile and the emergence of antibiotic-resistant pathogens. An increased prevalence of multi-drug resistant bacteria in SBP cases was reported [9, 10]
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