Propensity-score matched analysis shows spontaneous bacterial peritonitis secondary to non O1/non O139 Vibrio cholera infection results in poor outcome

Abstract

Background and Aim: We analyse clinical course of cirrhotic patients with non-O1/non-O139 Vibrio cholera (NOVC) bacteraemia and/or bacterascites. Methods: Electronic medical records of cirrhotic patients admitted with spontaneous bacterial peritonitis during 2010-2020 were filtered to recruit patients with NOVC isolated in blood or ascites and patients with E. coli bacteraemia/ bacterascites (comparator group). Both the groups were matched a-priori for the date of admission (within 5-days). Baseline parameters and in-hospital outcomes were recorded and compared using non-parametric tests. Both were propensity-matched for baseline parameters (age and Child’s score) and compared for in-hospital outcomes. Results: Of the 2545 patients admitted with spontaneous bacterial peritonitis during the study period, 29 had NOVC isolated (M: F:23:6; Age: 39, 18-54 years; median, range; MELD score: 25, 12-38; Child’s score: 11, 10-12.5) from either blood (26) or ascites (3) or both (8). Of these, 26 isolates were pan-sensitive, and all were sensitive to the initial empirical antibiotic. Fifty-three patients with E. coli isolated (M: F: 43:10; Age: 48, 18-69 MELD score: 25, 20-32; Child’s score:12, 11-13) from blood (31), ascites (17) or both (5) during the similar timeframe were recruited. Of these, 48 isolates were sensitive to empirical antibiotics initially utilised. Overall, 15/ 29 (death: 12; discharge in terminal state: 3) patients with NOVC and 21/53 (death: 19; discharge in terminal state: 2) had an adverse in hospital outcome (p-value: 0.148). On propensity-score matching, 29 comparable E. coli patients (age:41, 18-55 years; MELD score: 24, 19-31; Child’s score: 12, 11-13) had lesser circulatory failure at admission 4(13%) vs 14(49%; p-value:0.1) and significantly lower in-hospital adverse outcome (6/ 29) as compared to NOVC group (15/29; p-value: 0.028). Conclusions: Non-O1/Non-O139 Vibrio cholera, a rare cause of spontaneous bacterial peritonitis, had higher circulatory failure and is associated with significantly higher mortality.