Sa1033 Oral Nutrition With a High Content of BCAA Improves the Liver Function and Major Symptoms of Decompensated Cirrhotic Patients Unresponsive to BCAA Granules Only

Abstract

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is a frequent and severe bacterial infection in patients with decompensated cirrhosis and ascites. Most organisms causing SBP are from intestinal microbial flora with Enterobacteriaceae and Escherichia coli being reported the most common organisms. However, studies of small series in recent years reported increasing frequency of SBP caused by Gram -positive bacteria in SBP. AIM: To evaluate microbial characteristics of ascitic fluid in cirrhotic patients with spontaneous bacterial peritonitis. METHODS: Medical records of 236 patients who underwent diagnostic paracentesis from July 1 2006 to July 1 2011 at Hershey Medical Center were reviewed. Pertinent data were collected and analyzed using SAS 1.1 software. RESULTS: One hundred ninety eight patients, age between 18-80 years old who had cirrhosis and ascites were included. The majority of the patients with end stage liver disease had either alcoholic liver disease or viral hepatitis or both. 145 (73.2%) were males and 53 (26.8 %) were females. Mean age was 54.8 years. Total 650 cultures were performed. 153 out of 650 cultures (23.5%) met criteria of spontaneous bacterial peritonitis based on absolute neutrophil count in ascitc fluid >250 cells/mm3. Bacteria grew in 86 cultures. 21 of the 86 cultures grew 2 or more micro-organisms, possible secondary to contamination, were excluded from this analysis. One culture grew candida. Fifty out of 64 (78.1%) cultures grew Gram-positive bacteria and 14/64 (21.9%) cultures grew Gram-negative bacteria. Most common organism isolated was coagulase negative Staphylococcus and the most common Gram-negative organism isolated was Klebsiella. Positive culture result of either Gram-positive or Gram-negative bacteria did not differ in age, MELD score, frequency of paracentesis, etiology of liver disease, or previous history of SBP. CONCLUSION: Our study shows increased frequency of Grampositive bacteria in patients with SBP which is a change in the pattern of SBP compared to current guideline. Larger prospective studies are needed to confirm this finding. The implication of such change is likely to modify treatment strategies particularly when empiric therapy is contemplated.