Culture-negative Ascites Research Articles

Laparoscopic peritoneal lavage – a new treatment strategy in spontaneous bacterial peritonitis and liver cirrhosis

Introduction Bacterial infections in cirrhotic patients represent a major clinical problem, occuring 4-5 times more frequently compared to the general population and increasing mortality by leading to acute on chronic liver failure, subsequent decompensation, and multiorgan failure. The study’s purpose is to determine the possibilities of laparoscopy in the treatment of spontaneous bacterial peritonitis with decompensated liver cirrhosis. Materials and methods A retrospective descriptive study was conducted on 82 patients diagnosed with liver cirrhosis and spontaneous bacterial peritonitis, who were admitted to the Constantin Tibirna Surgery department No2, Holy Trinity Municipal Clinical Hospital and the Scientific Research Laboratory of Hepatic Surgery, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, between January 2012 and December 2021. Patients who underwent surgical drainage of the abdominal cavity by laparoscopy with postoperative peritoneal lavage with antibiotics were selected. All patients received standard treatment for the correction of liver function and complications of portal hypertension. The data were extracted from the medical records of the hospital archive, and the patient database was compiled. Data analysis was performed using simple statistical calculations. Results Positive ascitic fluid bacterial culture was in 29.2% (24 patients), while 70.7% (58 patients) had culture-negative ascites and peritonitis. The most frequent bacterial species was E. coli, present in 54.1% (13 patients). Mortality was 8.5% (7 patients) due to progressive liver failure. Recurrence of ascites and peritonitis at 1 month was 6.0% (5 patients). Conclusions The laparoscopic approach in spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis allows for better sanitation of the abdominal cavity, improves peritoneal absorption, and deserves establishment as clinical practice for patients with ascites and peritonitis and cirrhosis.

Prevalence of Culture Negative Asitic Fluid Infection among Chronic Liver Disease Patients

Background and Aim: Ascitic fluid infection is pre-existing ascites infection of both symptomatic and asymptomatic types without abdominal source in chronic liver disease patients. Culture negative ascites are common infections in patients with chronic liver disease. The aim of the recent study was to determine the prevalence of culture-negative ascitic fluid infection among chronic liver disease patients. Methodology: This cross-sectional study was conducted on 134 patients with ascitic fluid infection due to chronic liver disease in the Department of Medicine and Gastroenterology, Pak International Medical College, Peshawar for six months duration from December 2020 to May 2021. All the ascitic infectious patients due to chronic liver disease regardless of their age and gender showing ascitic fluid infection symptoms such as tenderness, fever, and abdominal pain were admitted and underwent laboratory culture examination. Based on bacterial growth, all the chronic liver disease patients were grouped into two; Group-I of no bacterial growth and Group-II of positive bacterial growth. All the patients having an intra-abdominal infection or taking antibiotics were excluded. Results: Of the total 134 patients, 84 (62.7%) were male and 50 (37.3%) were females. Overall mean age was 47.56±19.8 years with an age range of 20 years to 80 years. Of the total 134 cases, the prevalence of positive and negative culture ascites were 30 (22.4%) and 104 (77.6%) respectively. out of 104 culture-negative patients, 65 (62.5%) were male patients whereas 39 (37.5%) were females. Chronic liver disease means duration was 8.9±2.6 months with a range of 6 months to 18 months. For all the patients above 40 years, the prevalence of culture-positive and negative ascitic infection was 20 (66.7%) and 77 (74.1%) respectively. The prevalence of male patients was higher (62.5%) among culture-negative patients due to chronic liver disease. Conclusion: Our study found that the prevalence of culture-negative ascitic fluid was higher at 77.6% among male patients. Also, ascitic fluid infection due to chronic liver disease was higher in patients of age above 40 years. Keywords: Ascitic fluid, Culture-negative ascitic fluid infections, Chronic liver disease

The bacterial spectrum of spontaneous bacterial peritonitis in patients with cirrhosis of liver.

Objectives: To identify the bacterial spectrum of SBP in patients with cirrhosis of liver. Study Design: Descriptive Cross-sectional study. Setting: Department of Gastroenterology and Hepatology, Madina Teaching Hospital, Faisalabad. Period: 1st November, 2018 – 30th June, 2019. Material & Methods: Two hundred and fifty cirrhotic patients having ascites and clinical symptoms and signs of SBP, consecutively admitted in the ward or presented to OPD were included in the study. Results: A total of 250 patients included in this study. SBP was diagnosed according to the predetermined criteria in 140 patients. The culture-negative ascites was found in 77 (55%) and culture-positive ascites was found in 63 (45%) patients. The most common organism was E.Coli 28 (47.45%) followed by Enterococcus 10 (16.94%), Klebsiella Pneumoniae 6 (10.17%), Streptococcal Pneumoniae 5 (8.47%), S.aureus 5 (8.47%), Acinetobacter 3 (5.08%) and miscellaneous 2 (3.38%). Conclusion: The percentage of SBP is quite high among patients having cirrhosis and ascites and the Gram-negative bacterial spectrum is still much common in our region.

Prevalence of culture negative ascitic fluid infection among patients with chronic liver disease.

Objectives: To determine prevalence of patients with chronic liver disease having culture negative ascitic fluid infection. Study Design: Cross sectional study. Setting: Gastroenterology and medicine ward of DHQ Teaching Hospital Gujranwala. Period: January 2018 August 2018 having total duration of 8 months. Material & Methods: All patients irrespective of age and gender, having ascites due to chronic liver disease and showing signs and symptoms of ascitic fluid infection like fever, abdominal pain and tenderness, admitted in the medical unit of study hospital underwent ascitic tap and fluid was sent for culture examination to the hospital laboratory. Patients with chronic liver disease having no bacterial growth found on culture of ascitic fluid were placed in one group and who had culture positive ascites were placed in separate group. Patients who have taken any antibiotic in last one month or having any intra abdominal source of infection were excluded from the study. All cases in study group were already diagnosed with CLD. Results: There were 160 cases included in this study having chronic liver disease and ascitic fluid infection with 62.5% male and 37.5% female cases. Out of 160 cases, 22.5% were having culture positive ascites while 77.5% cases were having culture negative ascites among them 61% were male and 39% were female in positive group and 62.9% were male and 37.1% were female cases in negative group. Age range of patients was 25-75 years with mean age of 50±25 years. Mean duration of chronic liver disease was 9.5±2.4 months with minimum duration of 6 months and maximum duration of 15 months. There were 72.6% cases with culture negative ascites and 69.4% with positive culture were having age above 45 years. There was majority of male patients (62.9%) having culture negative ascites due to CLD. Conclusion: Ascitic fluid infection among patients with chronic liver disease is usually culture negative. In our study prevalence of culture negative ascitic flud infection was 77.5%, more common among male patients having age above 45 years.

SPONTANEOUS BACTERIAL PERITONITIS;

Objectives: To determine the frequency of culture positive (SBP) and culture negative spontaneous bacterial peritonitis (neutrocytic ascites) in cirrhotic population. Period: The six months (November 08th 2012 to May 07th 2013). Study Design: Descriptive cross-sectional study. Setting: Department of Gastroenterology at Liaquat National Hospital. Total 107 patients of liver cirrhosis with ascites admitted in our hospital. All the specific patients had ascitic fluid DR and C/S were enrolled and evaluated. Patient’s information was recorded on proforma and analyzed by using SPSS-20.0. Results: SBP was detected in 10 7 patients aged between 18 and 67 years included in study. Out of 107 patients with SBP 23 (21.5%) were culture positive while 84 (78.5%) were culture negative. In the culture positive group,19 (82.6%) were male and 4 (17.4%) were female while in culture negative group 46 (54.76%) were male and 38 (45.24%) were female. The ascitic fluid mean total leukocyte count in patients with culture positive ascites was 5140.39 /mm3 and in culture negative ascites was 2654.26 / mm3. The ascitic fluid mean neutrophils count in subjects with culture positive ascites was 75.57% and in culture negative ascites was 76.02%. The ascitic fluid mean lymphocyte count in individuals had culture positive ascites was 26.09 % and in subjects had culture negative ascites was 23.97%. Conclusion: Frequency of culture negative ascites is greater than culture positive ascites in SBP. The ascitic fluid mean total leucocyte count for culture positive ascites is greater than culture negative ascites. Mortality is high in culture positive ascites.

Characterisation of bacteria in ascites—reporting the potential of culture-independent, molecular analysis

Spontaneous bacterial peritonitis (SBP) is a severe complication of liver disease. A significant proportion of patients have culture-negative ascites, despite having similar signs, symptoms and mortality to those with SBP. Therefore, empirical antibiotic treatment for infection is often started without knowledge of the causative organisms. Here, we investigated the potential of molecular techniques to provide rapid and accurate characterisation of the bacteria present in ascitic fluid. Ascites samples were obtained from 29 cirrhotic patients undergoing clinically indicated therapeutic paracentesis. Bacterial content was determined by terminal restriction fragment length polymorphism (T-RFLP) analysis, quantitative polymerase chain reaction (PCR) and 16S ribosomal clone sequence analysis. Bacterial signal was detected in all samples, compared to three out of ten using standard methods. Bacterial loads ranged from 5.5 x 10(2) to 5.4 x 10(7) cfu/ml, with a mean value of 1.9 x 10(6) cfu/ml (standard deviation +/- 9.6 x 10(6) cfu/ml). In all but one instance, bacterial species identified by culture were also confirmed by molecular analyses. Preliminary data presented here suggests that culture-independent, molecular analyses could provide rapid characterisation of the bacterial content of ascites fluid, providing a basis for the investigation of SBP development and allowing early and targeted antibiotic intervention.

Outcomes in culture positive and culture negative ascitic fluid infection in patients with viral cirrhosis: cohort study

BackgroundAscitic fluid infection (AFI) in cirrhotic patients has a high morbidity and mortality. It has two variants namely, spontaneous bacterial peritonitis (SBP) and culture negative neutrocytic ascites (CNNA). The aim of this study was to determine the outcome in cirrhotic patients with culture positive (SBP) and culture negative neutrocytic ascites.MethodsWe analyzed 675 consecutive hepatitis B and/or C related cirrhosis patients with ascites admitted in our hospital from November 2005 to December 2007. Of these, 187 patients had AFI; clinical and laboratory parameters of these patients including causes of cirrhosis, Child Turcotte Pugh (CTP) score were recorded.ResultsOut of 187 patients with AFI, 44 (23.5%) had SBP while 143 (76.4%) had CNNA. Hepatitis C virus (HCV) infection was the most common cause of cirrhosis in 139 (74.3%) patients. Patients with SBP had high CTP score as compared to CNNA (12.52 ± 1.45 vs. 11.44 ± 1.66); p < 0.001. Platelets count was low in patients with SBP (101 ± 53 × 109/L) as compared to CNNA (132 ± 91 × 109/L), p = 0.005. We found a high creatinine (mg/dl) (1.95 ± 1.0 vs. 1.44 ± 0.85), (p = 0.003) and high prothrombin time (PT) in seconds (24.8 ± 6.6 vs. 22.4 ± 7.2) (p = 0.04) in SBP as compared to CNNA. More patients with SBP (14/44; 31.8%) had blood culture positivity as compare to CNNA (14/143; 9.8%), p = 0.002. Escherichia. Coli was the commonest organism in blood culture in 15/28 (53.5%) patients. SBP group had a higher mortality (11/44; 25%) as compared to CNNA (12/143; 8.4%), p = 0.003. On multiple logistic regression analysis, creatinine >1.1 mg/dl and positive blood culture were the independent predictors of mortality in patients with SBP.ConclusionPatients with SBP have a higher mortality than CNNA. Independent predictors of mortality in SBP are raised serum creatinine and a positive blood culture.

Endotoxin levels in cirrhotic rats with sterile and infected ascites.

Endotoxin levels were measured in sterile and bacterially infected ascites in a rat model of phenobarbital and carbon tetrachloride induced cirrhosis was used. An improved chromogenic substrate assay was used to measure endotoxin. All rat ascites specimens were positive for endotoxin. In culture-negative ascites (n = 8), it ranged from 0.05 EU/ml to 0.14 EU/ml (0.08 +/- 0.04 EU/ml, mean +/- SD) (Escherichia coli 0111:B4 endotoxin was used as a reference). In culture-positive ascites (premortem n = 3, postmortem n = 1), it ranged from 0.78 EU/ml to 1.8 EU/ml (1.29 +/- 0.59 EU/ml, mean +/- SD). All rats with premortem culture-positive ascites died within two days. This model is useful to study ascites endotoxin levels. In this study, increasing levels of ascites endotoxin correlated with spontaneous bacterial peritonitis and death.