Spontaneous Bacteria Peritonitis Research Articles

Prevalence of Spontaneous Bacteria Peritonitis in Patients with Hypoalbuminemia and Cirrhosis

Background and Aim: Spontaneous bacterial peritonitis (SBP) is one of the most serious complications of ascites, resulting in liver cirrhosis infection, accounting for approximately 25% of all bacterial infections. Within a diagnostic year, the mortality rate for spontaneous bacterial peritonitis ranges from 30% to 90%. The current study attempted to determine the prevalence of spontaneous bacterial peritonitis in patients with hypoalbuminemia and cirrhosis. Materials and Methods: This cross-sectional study was conducted on 112 cirrhosis with hypoalbuminemia patients at Medical Unit A, Hayatabad Medical Complex Peshawar and department of Gastroenterology AK CMH / Sheikh Khalifa bin Zaid Al Nahyan Hospital, Rawalakot Azad Kashmir. The duration of the study was six months from 5th January 2021 to 5th June 2021. All patients of either gender with liver cirrhosis and hypoalbuminemia aged 20 to 60 years were included in the study. Each individual was asked to provide written informed consent. Each patient's creatinine, albumin, and sodium levels were measured in the laboratory using urine and blood sample tests. Each patient's absence or presence of SBP was recorded according to the operational definition. For data analysis, SPSS version 20 was used. Results: Of the total 112 patients, 59 (52.7%) were male and 53 (473%) were female. The overall mean age of the patients was 43.51±4.58 years whereas male and female patients had 47.36±5.62 and 39.66±3.54 years respectively. The number of patients falling in class B and Child Push class C was 50 (44.6%) and 62 (55.4%) respectively. The prevalence of spontaneous bacterial peritonitis was 48 (42.9%). Out of 48 SBP patients, 29 (60.4%) were male and 19 (39.6%) were female. The prevalence of SBP was seen in 13 (27.1%) cases of Class B and 35 (72.9%) of Class C (Child-Pugh Class) respectively. Hypertension and diabetes mellitus as comorbidities were present in 11 (9.8%) and 25 (22.3%) cases respectively. Conclusion: In the current study, the prevalence of SBP was 42.9%. Our study revealed a higher prevalence of spontaneous bacterial peritonitis in cirrhosis patients. Also, a significant association has been found between spontaneous bacterial peritonitis and child Pugh Class C and Class B whereas SBP had no substantial connotation with gender, etiology, and even age but with disease duration. Keywords: Cirrhosis; Spontaneous Bacterial Peritonitis; Hypoalbuminemia

A prediction model for outcome in patients with HBV-ACLF based on predisposition, injury, response and organ failure

We aimed to develop a prediction model based on the PIRO concept (Predisposition, Injury, Response and Organ failure) for patients with Hepatitis B Virus (HBV) related acute-on-chronic liver failure (ACLF). 774 patients with HBV related ACLF defined in the CANONIC study were analyzed according to PIRO components. Variables associated with mortality were selected into the prediction model. Based on the regression coefficients, a score for each PIRO component was developed, and a classification and regression tree was used to stratify patients into different nodes. The prediction model was then validated using an independent cohort (n = 155). Factors significantly associated with 90-day mortality were: P: age, gender and ACLF type; I: drug, infection, surgery, and variceal bleeding; R: systemic inflammatory response syndrome (SIRS), spontaneous bacteria peritonitis (SBP), and pneumonia; and O: the CLIF consortium organ failure score (CLIF-C OFs). The areas under the receiver operating characteristics curve (95% confidence interval) for the combined PIRO model for 90-day mortality were 0.77 (0.73–0.80). Based on the scores for each of the PIRO components and the cut-offs estimated from the classification and regression tree, patients were stratified into different nodes with different estimated death probability. Based on the PIRO concept, a new prediction model was developed for patients with HBV related ACLF, allowing stratification into different clusters using the different scores obtained in each PIRO component. The proposed model will likely help to stratify patients at different risk, defining individual management plans, assessing criteria for specific therapies, and predicting outcomes.

Prevalence of Spontaneous Bacterial Peritonitis in Cirrhotic Patients with Ascites and Its Pattern in Aswan University Hospital

Background: Spontaneous bacterial peritonitis (SBP) is the most common infection and a lethal complication in patients with liver cirrhosis and ascites. It has high mortality and recurrence rates and poor long-term prognosis. Objective: This study was done to determine the prevalence of spontaneous bacterial peritonitis and its variants in patients of liver cirrhosis with ascites. Patients and Methods: This was a prospective, randomized, cross-sectional clinical study, included 100 adult patients of decompensated liver cirrhosis with ascites in Aswan University Hospital during the period from January 2019 to December 2019. Results: Diagnosis of SBP is based on ascitic fluid analysis as well as culture and sensitivity. The diagnostic criteria are PMNL > 250/mm³ and or positive culture. Mean of age of patients was 63.06 ± 9.67 years old. Majority of patients were males (63%) and 37 % were females. In Our study, 62% of patients were diagnosed SBP. Classic SBP in 30.6%, Culture Negative Neutrocytic Ascites (CNNA) in 59.7% and MNB in 9.7% of patients. Of 25 patients who have positive culture ascetic fluid, 60% were positive for gram-negative bacteria predominantly E. coli. Conclusion: Spontaneous Bacteria Peritonitis is the most common and life-threatening infection in patients who have liver cirrhosis and ascites. It is diagnosed by a) Ascitic fluid PMNL > 250/mm³. b) Positive ascetic fluid culture. c) Both a and b. It is found that SBP has recently increased in prevalence with predominantly causative organism gram negative E Coli.

Prevalence of Spontaneous Bacterial Peritonitis in Cirrhotic Patients with Ascites and Its Pattern in Aswan University Hospital

Background: Spontaneous bacterial peritonitis (SBP) is the most common infection and a lethal complication in patients with liver cirrhosis and ascites. It has high mortality and recurrence rates and poor long-term prognosis. Objective: This study was done to determine the prevalence of spontaneous bacterial peritonitis and its variants in patients of liver cirrhosis with ascites. Patients and Methods: This was a prospective, randomized, cross-sectional clinical study, included 100 adult patients of decompensated liver cirrhosis with ascites in Aswan University Hospital during the period from January 2019 to December 2019. Results: Diagnosis of SBP is based on ascitic fluid analysis as well as culture and sensitivity. The diagnostic criteria are PMNL > 250/mm³ and or positive culture. Mean of age of patients was 63.06 ± 9.67 years old. Majority of patients were males (63%) and 37 % were females. In Our study, 62% of patients were diagnosed SBP. Classic SBP in 30.6%, Culture Negative Neutrocytic Ascites (CNNA) in 59.7% and MNB in 9.7% of patients. Of 25 patients who have positive culture ascetic fluid, 60% were positive for gram-negative bacteria predominantly E. coli. Conclusion: Spontaneous Bacteria Peritonitis is the most common and life-threatening infection in patients who have liver cirrhosis and ascites. It is diagnosed by a) Ascitic fluid PMNL > 250/mm³. b) Positive ascetic fluid culture. c) Both a and b. It is found that SBP has recently increased in prevalence with predominantly causative organism gram negative E Coli.

Acid suppression therapy and its association with spontaneous bacterial peritonitis incidence: A systemic review and meta-analysis.

It is well known that the use of proton pump inhibitor (PPI) is widespread in patients with liver cirrhosis. PPI counteracts H2 receptor inhibitor (H2 RA) with its strong acid suppression effect. However, there is always a concern that PPI use may increase spontaneous bacteria peritonitis (SBP) development in cirrhotic patients. We aimed to investigate the association between acid suppression therapy (i.e. PPI or H2 RA) and SBP through meta-analysis. We searched PubMed, Medline, Web of Science, Cochrane library, and Embase for relevant studies published up to April 2019. Pooled OR and 95% CI were calculated by a random-effects model. Funnel plots and Egger's tests were performed for the evaluation of publication bias. Non-parametric "trim-and-fill" tests were conducted for sensitivity analysis. A total of 20 original articles including 9566 cirrhotic patients were analyzed. The overall meta-analysis highlighted that PPI use was associated with the risk of SBP (pooled OR 1.77, 95% CI 1.49-2.11). The conclusion was irrespective of study methods, whereas the result was inconsistent only in South America. However, the conclusion might not be stable enough and should be extrapolated with caution. Unlike PPI, we found H2 RA was not associated with SBP (pooled OR 1.06, 95% CI 0.75-1.48). In conclusion, PPI use, but not H2 RA, will increase the incidence of SBP in cirrhotic patients. In addition, H2 RA might be beneficial for patients who require long-term acid suppression therapy.

Infection in cirrhosis: A prospective study

Introduction and objectivesMultidrug-resistant (MDR) infections in cirrhosis are associated with poor outcomes. We attempted a prospective study on infections in patients with cirrhosis evaluating microbiology of these infections and how outcomes depended on factors like bacterial resistance, appropriate antibiotics, stage of liver disease and whether outcomes were significantly different from patients who did not have infections. Materials and methodsThis was a prospective evaluation involving one hundred and fifty nine patients with cirrhosis who were admitted at Peerless Hospitex Hospital and Research Center, Kolkata, West Bengal, India, during a 24 month period. One hundred and nineteen of these patients either had an infection at the time of admission or developed infection during hospitalization. Forty patients did not have an infection at admission and did not acquire infection while admitted. Data was collected about demographics, etiology of cirrhosis, liver and renal function and microbiology. ResultsInfections were community acquired in 27.7% of patients, healthcare associated in 52.9% and nosocomial in 19.3%. Gram negative bacilli (Escherichia coli 47.4% Klebsiella pneumoniae 23%) were common. 84.9% of enterobacteriaceae produced ESBL, AmpC or Carbapenemases. Spontaneous bacteria peritonitis (SBP) and urinary tract infection (UTI) were the most common sites of infection. In hospital mortality was 21.9%. Non-survivors had higher MELD (26 vs 19, p<0.001) and CTP scores (11.7 vs 10.3, p<0.001). The control group had lower MELD (16.65 vs. 20.8, p<0.001) and CTP scores (9.25 vs 10.59, p<0.001). ConclusionsMDR infections are common in patients with cirrhosis and have serious implications for treatment and outcomes.

Short-term efficacy of treating hepatitis B virus-related acute-on-chronic liver failure based on cold pattern differentiation with hot herbs: A randomized controlled trial.

To evaluate the clinical efficacy and safety of Yinchen Zhufu Decoction (, YCZFD) in the treatment of acute-on-chronic liver failure caused by hepatitis B virus (HBV-ACLF) with cold pattern in Chinese medicine (CM). This is a multi-center randomized controlled trial of integrative treatment of CM and Western medicine (WM) for the management of HBV-ACLF patients. A total of 200 HBV-ACLF patients with cold pattern were equally randomly assigned to receive YCZFD and WM (integrative treatment) or WM conventional therapy alone respectively for 4 weeks. The primary end point was the mortality for HBV-ACLF patients. Secondary outcome measures included Model for End-Stage Liver disease (MELD) score, liver biochemical function, coagulation function and complications. Adverse events during treatment were reported. The mortality was decreased 14.28% in the integrative treatment group compared with WM group (χ(2) =6.156, P=0.013). The integrative treatment was found to signifificantly improve the MELD score (t=2.353, P=0.020). There were statistically signifificant differences in aspartate transaminase, total bilirubin, indirect bilirubin, direct bilirubin and prothrombin time between the two groups (P<0.05 or P<0.01). The complications of ascites (χ(2)=9.033, P=0.003) and spontaneous bacteria peritonitis (χ(2)=4.194, P=0.041) were improved signifificantly in the integrative treatment group. No serious adverse event was reported. The integrative treatment of CM and WM was effective and safe for HBV-ACLF patients with cold pattern in CM. The Chinese therapeutic principle "treating cold pattern with hot herbs" remains valuable to the clinical therapy. (Trial registration No. ChiCTR-TRC-10000766).

Increase in Group G Streptococcal Infections in a Community Hospital, New York, USA

To the Editor: Identified in 1935 by Lancefield and Hare, group G streptococci (GGS) are part of the normal flora of the pharynx, gastrointestinal tract, genital tract, and skin (1–3). However, previous case reports have indicated that GGS also could cause complicated infections, including cellulitis, osteomyelitis, septic arthritis, meningitis, endocarditis, and bacteremia (3–6). Since the mid-1980s, several studies worldwide have reported an increasing incidence of GGS bacteremia (1,5–8), but no recent study has been conducted in the United States to determine the incidence of overall GGS infection. We noticed that an increasing number of patients with GGS have been admitted to Long Island College Hospital in Brooklyn, New York, USA, during the past few years. To better understand the trend of GGS infection in our institution, we retrospectively reviewed charts of patients admitted from January 2003 through December 2007 who had microbiologically proven GGS infection. Inclusion criteria were clinically and microbiologically documented GGS infection in patients who received appropriate antimicrobial drugs and were >18 years of age. Lancefield GGS were identified in the laboratory by latex agglutination test; resistance profiles were not done for GGS. A total of 73 persons with GGS were admitted to the hospital during the 5-year study period; the number of patients admitted increased yearly (Figure). Mean age of patients was 53 years; most (77%) were <65 years of age; 52% were women, and most (61%) patients were African American. Thirty (41%) patients had polymicrobial infections; other identified organisms included methicillin-susceptible Staphylococcus aureus (8 [11%]), methicillin-resistant S. aureus (MRSA) (9 [12%]), and gram-negative or anaerobic organisms (13 [18%]). Figure Annual number of patients with group G streptococcal infections admitted to Long Island College Hospital, Brooklyn, New York, USA, 2003–2007. The spectrum of GGS infections ranged from mild skin and soft tissue infection (34 [46%]) to invasive diseases, including urogenital infection (7 [10%]); lower respiratory tract infection (7 [10%]); pharyngitis (6 [8%]); endocarditis and catheter infection (5 [7%]); and others (14 [19%]), such as peritonitis, pelvic abscess, rectal abscess, and septic arthritis. Four of the 6 persons with pharyngitis were assumed to be colonized with the organism. Eight (24%) of 34 skin and soft tissue infections were associated with bacteremia, 5 (15%) with osteomyelitis, and 20 (59%) with polymicrobial infections. Six persons with lower respiratory tract infections and 1 each with endocarditis, genital tract infection, pelvic abscess, and dental abscess also had polymicrobial infections. Eighteen persons had bacteremia, the trend of which also increased yearly. Of these, 8 had skin and soft tissue infections, 4 had endocarditis, 2 had urinary tract infections, 1 had possible spontaneous bacteria peritonitis, and 1 had hemodialysis catheter infection; 2 were of unknown source. Of the patients with endocarditis, 2 had vegetations on the native valves, 1 had a pacemaker infection, and 1 had prosthetic valve vegetation. One case of native valve endocarditis occurred in a tricuspid valve in an injection drug user. Another case occurred in a patient in which an epidural abscess was associated with an aortic valve vegetation. Most of the patients had underlying medical conditions; 34% had diabetes mellitus. In contrast to previous reports, which stated that malignancy was the most common underlying disease (2,3), only 7 (10%) of the patients in our study group had underlying malignancy, of whom 4 had active malignancy and the rest had had previous malignancy. Nine patients with a history of injection drug use and 5 with HIV infection were identified; the patient with bacteremia secondary to hemodialysis catheter infection had a history of both HIV and intravenous drug use. Three (4%) patients died; their deaths were unlikely to be attributable to GGS because all were elderly (78–92 years) and had underlying coexisting conditions and co-infections. All 4 persons with endocarditis and the patient with the catheter infection survived. Five patients who were co-infected with MRSA were treated with vancomycin or daptomycin; the remainder were treated with β-lactam antimicrobial drugs and had the sources of infection (catheter or pacemaker) removed. When infections caused by gram-negative or anaerobe organisms were identified, they were also treated with appropriate antimicrobial drugs. The overall average length of stay for all patients with GGS was 9.4 days, with longer stays for those with underlying diabetes mellitus (14.6 days) than for those without diabetes (6.7 days). GGS was an important etiologic agent for a wide spectrum of infections. Its impressive increase in our institution during the past 5 years raises concerns because other types of β-hemolytic streptococcal infection have increased recently. Group A and B (9,10) increased substantially during the 1980s. A multicenter analysis may confirm GGS as an emerging human pathogen and may help us better understand the reason for this increase.

Pasteurella multocida as a cause of spontaneous bacteria peritonitis (SBP) and empyema in a patient with cirrhosis

Pasteurella multocida as a cause of spontaneous bacteria peritonitis (SBP) and empyema in a patient with cirrhosis