Abstract
Spontaneous bacterial peritonitis occurred on 44 separate occasions in 43 patients during a five year period, including 27 culture positive and 17 probable cases of spontaneous bacterial peritonitis. Alcoholic liver disease was the underlying cause of 72% of cases. Of the 27 culture positive cases, Escherichia coli was the most common isolate (14 cases), followed by Klebsiella pneumoniae (three cases), group G streptococci (three cases), group B streptococci (two cases) and one case each of five other organisms. Bacteremia occurred in 50% of cases and was the same as the peritoneal isolate 88% of the time. The overall mortality rate was 65% (66% culture positive and 60% probable spontaneous bacterial peritonitis). The mean interval between onset of symptoms and death was 10.2±8.6 days in fatal cases. Spontaneous bacterial peritonitis was felt to be a contributing cause of mortality in 70% of fatal cases. Survivors were younger (44±20 years versus 59±13, P<0.05) and less likely to develop renal insufficiency than nonsurvivors (38% versus 73%, P<0.05). Patients who were treated with an aminoglycoside were more likely to develop renal failure compared to those treated with nonaminoglycoside regimens (P<0.05). There was no difference in mortality rate between culture positive and culture negative spontaneous bacterial peritonitis, total peritoneal leukocyte counts, Gram-positive versus Gram-negative organisms, presence of bacteremia, or serum albumin or bilirubin levels. The mortality rate for this disease remains unacceptably high, indicating a need for the development of new strategies in the prevention, diagnosis and management of this disease.
Highlights
With the advent of second and third generation cephalosporins as well as other antimicrobial agents, alternative regimens in the treatment of spontaneous bacterial peritonitis have become available to the clinician. The authors analyze their experience in the treatment of spontaneous bacterial peritonitis, comparing the results obtained with newer antimicrobial agents with those of a traditional aminoglycoside-containing regimen
Criteria for inclusion as culture positive spontaneous bacterial peritonitis included: a positive peritoneal fluid culture; clinical features of ascites; and absence of a secondary cause of infection
Each patient had greater than 500x10 /L neutrophils in the ascitic fluid, except one patient with culture positive spontaneous bacterial peritonitis. This patient had Clostridium tertium cultured from the blood and peritoneal fluid, and died seven days from the onset ofspontaneous bacterial peritonitis from disseminated intravascular coagulation and refractory hypotension
Summary
The overall mortality rate was 65% (66% culture positive and 60% probable spontaneous bacterial peritonitis). Spontaneous bacterial peritonitis was felt to be a contributing cause of mortality in 70% of fatal cases. Une affection hepatique ethylique etait la cause sous-jacente dans 72 % des cas. On n·a releve aucune difference dans le taux de mortalite des cas de peritonite bacterienne spontanee avec cultures positives et negatives, ou selon la numeration leucocytaire peritoneale totale, les germes Gram positifs par rapport aux germes Gram negatifs, la presence d'une bacteriemie ou les taux d'albumine serique ou de bilirubine. The authors analyze their experience in the treatment of spontaneous bacterial peritonitis, comparing the results obtained with newer antimicrobial agents with those of a traditional aminoglycoside-containing regimen. The prognostic value of various clinical and laboratory parameters in determining the outcome of spontaneous bacterial peritonitis is reviewed
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