Spontaneous Bacterial Peritonitis In Patients Research Articles

Manual method versus flow cytometry for diagnosing spontaneous bacterial peritonitis

ABSTRACT Background Diagnosing spontaneous bacterial peritonitis (SBP) requires a high clinical index of suspicion because the clinical presentation varies widely. Early detection and treatment of SBP are crucial for improving survival rates. Ascitic fluid neutrophil count ≥ 250 cells/mm3 is the only required criterion to diagnose SBP, regardless of culture results. The most frequently used manual ascitic neutrophil counting is difficult and time-consuming, and it often leads to frequent delays in obtaining results and a possible under- or overestimation of the neutrophilic count. The flow cytometric counting provides results in 30 minutes and is more accurate, with sensitivity and specificity approaching 100%. Objective This study aimed to assess the diagnostic efficacy of manual counting of neutrophils in comparison to flow cytometry for detecting SBP. Patients and methods In a cross-sectional study, we included 140 cirrhosis-related ascites patients who were clinically suspected to have SBP and admitted to the Alexandria Main University Hospital in the Department of Internal Medicine. Participants with ≥ 250 neutrophil cells/mm3 in ascitic fluid by flow cytometry were defined as SBP patients. In contrast, those with fewer than 250 neutrophil cells/mm3 in ascitic fluid using the flow cytometric method were defined as patients without SBP. Results At a cutoff value of 250 cells/mm3, the ROC curve showed that the manual ascitic fluid method had lower sensitivity, specificity, positive and negative predictive values (67.19%, 86.84%, 81.13%, and 75.86%, respectively, with AUC = 0.945, 95% CI, 0.91–0.97, p < 0.001) in diagnosing SBP than the flow cytometric method. Conclusions Using the flow cytometric method significantly improved diagnostic precision. Its use may be recommended to replace the traditional manual method, which may have unaccepted false-negative results.

Comparison of Rifaximin Alone and With Quinolones in the Primary Prevention of Spontaneous Bacterial Peritonitis in Patients With Decompensated Chronic Liver Disease.

Background In cirrhotic patients with ascites, primary prevention of spontaneous bacterial peritonitis (SBP) is a key strategy to lower morbidity and death. Rifaximin and fluoroquinolone used alternately as main prophylaxis are as effective as reported. This study aimed to compare the frequency of occurrence of SBP in patients with decompensated chronic liver disease treated with rifaximin alone and in combination with fluoroquinolone. Methodology A total of 76 patients with hepatitis C virus-related decompensated chronic liver disease and ascites were divided into two groups based on matching age, sex, and Child-Pugh class. Group A (38 patients) received rifaximin 1,100 mg/day in two divided doses with daily fluoroquinolone 400 mg/day, whereas group B (38 patients) received rifaximin 1,100 mg/day alone as a two dosage. The patients were monitored for up to three months. The study's endpoints were SBP, hepatocellular carcinoma, compliance failure, death, or liver transplantation. Results In this comparative study involving 76 patients, the demographic and clinical characteristics were assessed across two treatment groups: rifaximin alone (n = 38) and rifaximin with fluoroquinolone (n = 38). The combination therapy demonstrated a statistically significant reduction in SBP compared to rifaximin alone. Additionally, the overall survival rate was higher in the combination group. These findings suggest potential benefits of the combined approach in managing hepatic encephalopathy-related complications. Conclusions When compared to rifaximin alone for primary SBP prophylaxis, the combination of rifaximin with fluoroquinolone exhibited greater effectiveness with the same safety profile.

MICROBIOLOGICAL ANALYSIS AND ANTIBIOTIC SUSCEPTIBILITY FOR SPONTANEOUS BACTERIAL PERITONITIS IN HOSPITALIZED PATIENTS WITH AND WITHOUT HEPATITIS C

In individuals with cirrhosis, spontaneous bacterial peritonitis (SBP) is a common and often fatal bacterial infection with ascites. The Pathological accumulation and collection of fluid in the peritoneal cavity is known as ascites. Ascites can be a challenging diagnosis. Individuals with or without underlying hepatitis C may have varying SBP. Antimicrobials are used to treat SBP, however because MDR organisms are present, initial empirical treatment may not be effective. The aim of the present study was to investigate the causative agents of ascites in SBP and to check antibiotic susceptibility of bacterial isolates. In recent study twenty-five SBP patients were prospectively studied. The ascitic fluid was inoculated in to conventional bacterial broth, agar culture and blood culture media. Among all tested bacterial species E. coli was the most isolated bacteria present in 23 samples out of 25. The presence of E.coli was 92% followed by Shigella spp (72%), Salmonella spp (68%), Enterobacter spp (60%), K. aerogenes (52%), S. aureus (32%), S. epidermidis (30%), A. israelii (28%), P. aeruginosa (24%), C. freundii (20%) and S. marcescens (08%). A total of six antibiotics were used to check antibiotic susceptibility pattern of bacterial isolates through disc diffusion method. The used antibiotics were Meropenem, Moxifloxacin, Ciprofloxacin, Ceftriaxone, Cefixime and vancomycin. Our results showed that most of isolated bacterial species were MDR (Multi drug resistant) except E.coli and A.israelii that were sensitive to used antibiotics. Meropenem was the most effective antibiotic against all tested bacterial species. Meropenem showed maximum zone of inhibition against S.auresus (34mm), followed by A. israelii (33mm), P.aeruginosa (32mm), C.freundii (31mm), S.marcescens (28mm), S.epidermidis (27mm), E.coli (26mm), Salmonella spp (23mm), K.aerogenes (21mm), Enterobacter spp (21mm) and Shigella spp (15mm). It is concluded that gram-positive and gram-negative multi-drug resistant bacteria were the most common cause of SBP in patients with and without hepatitis C and meropenem was the most effective antibiotic against all tested isolate

Effect of hypoalbuminemia on mortality in cirrhotic patients with spontaneous bacterial peritonitis.

The impact of hypoalbuminemia on the short-term and long-term mortality of cirrhotic patients with spontaneous bacterial peritonitis (SBP), both with and without renal function impairment, remains insufficiently elucidated based on population-based data. We retrieved data from Taiwan's National Health Insurance Database encompassing 14,583 hospitalized patients diagnosed with both cirrhosis and SBP during the period from January 1, 2010, to December 31, 2013. Prognostic factors influencing 30-day and 3-year survival were computed. Furthermore, the impact of hypoalbuminemia on the mortality rate among SBP patients, with or without concurrent renal function impairment, was also assessed. The 30-day mortality rates for patients with SBP, comparing those with hypoalbuminemia and those without, were 18.3% and 29.4%, respectively (P < 0.001). Similarly, the 3-year mortality rates for SBP patients with hypoalbuminemia and those without were 73.7% and 85.8%, respectively (P < 0.001). Cox proportional hazard regression analysis, adjusted for patients' gender, age, and comorbid conditions, substantiated that individuals with hypoalbuminemia exhibit an inferior 30-day survival (hazard ratio [HR]: 1.62, 95% confidence interval [CI]: 1.51-1.74, P < 0.001) and reduced 3-year survival (HR: 1.57, 95% CI: 1.50-1.63, P < 0.001) in comparison to those lacking hypoalbuminemia. Among SBP patients with renal function impairment, those presenting hypoalbuminemia also experienced diminished 30-day survival (HR: 1.81, 95% CI 1.57-2.07, P < 0.001) as well as reduced 3-year survival (HR: 1.70, 95% CI 1.54-1.87, P < 0.001). Likewise, in SBP patients without renal function impairment, the presence of hypoalbuminemia was associated with poorer 30-day survival (HR: 1.54, 95% CI 1.42-1.67, P < 0.001) and 3-year survival (HR: 1.53, 95% CI 1.46-1.60, P < 0.001). Among cirrhotic patients with SBP, the presence of hypoalbuminemia predicts inferior short-term and long-term outcomes, regardless of renal function.

The Incidence of Spontaneous Bacterial Peritonitis in Patients With Cirrhosis-Related Ascites Undergoing Elective Outpatient Large-Volume Paracentesis

The Incidence of Spontaneous Bacterial Peritonitis in Patients With Cirrhosis-Related Ascites Undergoing Elective Outpatient Large-Volume Paracentesis

Prognosis of spontaneous bacterial peritonitis in patients with hepatocellular carcinoma

BackgroundHepatocellular carcinoma (HCC) is the fourth leading cause of death from cancer worldwide. Spontaneous bacterial peritonitis (SBP) is associated with poor prognosis. This study aimed to evaluate risk factors, differences in clinical characteristics and prognosis of SBP in patients with HCC in comparison with non-HCC patients. MethodsThis study was conducted on patients with cirrhosis who were admitted to hospital with SBP. The patients were divided into two groups: SBP group with HCC (n = 150) and SBP group without HCC (n = 250). ResultsMen and women accounted for 72% and 28% (n = 108 and 42, respectively) of the population in SBP group with HCC with mean age 55.8 ± 13.1 years. They accounted for 68.4% and 31.6% (n = 171 and 79, respectively) in the SBP group without HCC with mean age 56.8 ± 10.5 years. In-hospital mortality was 25.3% in the SBP group with HCC and 18.8 % in SBP group without HCC. Gastrointestinal bleeding was the most common cause of death in both groups. No significant difference was observed in patient outcomes between the two studied groups. The deceased patients had significantly higher levels of leukocytes and neutrophils in ascitic fluid as well as a higher frequency of positive culture results than in patients who survived (p < 0.001). However, there was no significant difference in protein level in ascitic fluid or causative organism between patients who survived and those who died (p = 0.63 and 0.19, respectively). ConclusionsPrognosis of SBP in patients with HCC seemed similar to that in patients without HCC.

Quality improvement project demonstrating a sustained increase in the assessment and sampling of ascites for hospitalised patients with cirrhosis

ObjectiveUsing quality improvement techniques, we aimed to improve the rate of assessment and sampling of ascitic fluid for the purpose of diagnosing spontaneous bacterial peritonitis in patients with cirrhosis admitted...

A Study of Spontaneous Bacterial Peritonitis in Cirrhosis of Liver with Ascites at a Tertiary Care Hospital in North India: Prevalence, Clinical, and Microbiological Profile

Background and Objectives: In patients with chronic liver disease and ascites, spontaneous bacterial peritonitis (SBP) is a common complication. This can progress gradually and subtly or go undiagnosed until signs start to show. Early diagnosis is essential for effective treatment and the prevention of subsequent episodes because the mortality rate following a single episode varies from 20% to 40%. The goal was to study the incidence, clinical profile, and microbiological characteristics of SBP and its variants in people with liver cirrhosis and ascites. Materials and Methods: This observational study was done on 104 cirrhotic patients with ascites admitted at a tertiary care hospital. Basic demographics, symptoms, and clinical signs of patients were recorded. Diagnostic paracentesis was done aseptically and immediately sent for ascitic fluid cytology, biochemistry, and culture. Bacterial examination and antibiotic sensitivity tests were carried out by standard microbiological techniques. Results: Out of a total of 104 cirrhotic patients, 28 (26.9%) were diagnosed with SBP. Alcohol was the most common etiological factor, followed by hepatitis C infection. Among the SBP patients, the most common presentation was culture-negative neutrocytic ascites (71.4%), followed by classical SBP (17.8%), then mono bacterial non neutrocytic bacterascites MNB (10.7%). Among the symptoms, the most common was abdominal distension, followed by icterus, pedal edema, and abdominal pain. Majority of the patients belonged to Child–Pugh’s Grade C. Of 28 cases of SBP, 8 were culture positive. Gram-negative isolates were predominant (75%) and Escherichia coli were the most common isolate. Interpretation and Conclusion: The prevalence of SBP in cirrhotic patients was 26.9%, and Gram-negative isolates were predominant. Ascitic fluid culture and susceptibility testing can lead to accurate diagnosis of SBP and can guide for treatment as resistance to antibiotics is common.

S1341 Demographic Factors Associated With the Severity of Spontaneous Bacterial Peritonitis in Patients With Cirrhosis: A Retrospective Analysis

S1341 Demographic Factors Associated With the Severity of Spontaneous Bacterial Peritonitis in Patients With Cirrhosis: A Retrospective Analysis

The study of monocyte chemoattractant protein-1 gene expression and ascetic fluid calprotectin biomarker levels in spontaneous bacterial peritonitis patients with liver cirrhosis

The study of monocyte chemoattractant protein-1 gene expression and ascetic fluid calprotectin biomarker levels in spontaneous bacterial peritonitis patients with liver cirrhosis

Ascitic Calprotectin, as a New Marker of Spontaneous Bacterial Peritonitis (SBP)

Abstract Background Liver cirrhosis results from different mechanisms of live injury that lead to necroinflammation and fibrogenesis; histologically it is characterized by diffuse nodular regeneration surrounded by dense fibrotic septa with subsequent parenchymal extinction and collapse of liver structures, together causing pronounced distortion of hepatic vascular architecture. Objective To evaluate the diagnostic role of ascetic fluid calprotectin in cirrhotic patients with spontaneous bacterial peritonitis before and after treatment. Patients and Methods This study was designed as a case-control study for evaluation of ascitic calprotectin as a diagnostic &amp; prognostic test for spontaneous bacterial peritonitis. The study was conducted on 50 patients attended internal medicine department in El Dmerdash teaching hospital of Ain Shams University during 2018/2019. Results Regarding the ascetic calprotectin after treatment showed decreasing levels correlated with recovery among SBP patients with cut off ≤340 pg/ml had sensitivity 82.5%, specificity 78.0%, PPV 75.0%, NPV 84.8%, accuracy 82.6% in cirrhotic patients with SBP after treatment. Also, the present study found that ascetic calprotectin at cut off value ≤ 780 pg/ml had sensitivity 82.86%, specificity 100%, PPV 100%, NPV 45.5%, accuracy 96.3% in prediction of poor prognosis among SBP cirrhotic patients after treatment. Conclusion The best cut-off is level of ascitic calprotectin ≤ 320 pg/ml which had sensitivity 95%, specificity 90%, PPV 74.5%, NPV 81.8%, accuracy 94.1% in prediction of diagnosis of SBP among cirrhotic patients. The best cut-off level of Ascitic calprotectin ng/mL ≤ 780 pg/ml had sensitivity 82.86%, specificity 100%, PPV 100%, NPV 45.5%, accuracy 96.3% in prediction of poor prognosis among SBP cirrhotic patients after treatment.

Validation of a new simple scoring system to predict spontaneous bacterial peritonitis in patients with cirrhosis and ascites

BackgroundRecently, a simple scoring system named the Mansoura scoring system was developed to predict spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and ascites. However, the efficacy of this newly developed system has not been extensively investigated. We aimed to validate a new simple scoring system for the rapid diagnosis or exclusion of SBP without paracentesis.MethodsAdult patients with cirrhosis and ascites admitted to Cho Ray Hospital between November 2021 and May 2022 were included. The area under the receiver operating characteristic (AUROC) curve of the Mansoura simple scoring system for predicting SBP was calculated using the Stata software. Other independent laboratory tests for predicting SBP (C-reactive protein [CRP], neutrophil-to-lymphocyte ratio [NLR], and mean platelet volume [MPV]) were assessed and compared using the Mansoura scoring system.ResultsA total of 121 patients were included in this study. The Mansoura scoring system showed good performance in predicting SBP in patients with cirrhosis and ascites (AUROC:0.89). At the cut-off ≥ 4 points, the scoring system achieved a specificity of 97.7% with a positive predictive value for the diagnosis of SBP of 93.5%. Multivariate analysis was performed using our data and showed that NLR, CRP level, and MPV were independent factors related to SBP.ConclusionThe Mansoura scoring system demonstrated good performance in predicting SBP in patients with cirrhosis and ascites and may help guide management decisions.

A Validated Composite Score Demonstrates Potential Superiority to MELD-Based Systems in Predicting Short-Term Survival in Patients with Liver Cirrhosis and Spontaneous Bacterial Peritonitis-A Preliminary Study.

Spontaneous bacterial peritonitis (SBP) is a severe complication in cirrhosis patients with ascites, leading to high mortality rates if not promptly treated. However, specific prediction models for SBP are lacking. This study aimed to compare commonly used cirrhotic prediction models (CTP score, MELD, MELD-Na, iMELD, and MELD 3.0) for short-term mortality prediction and develop a novel model to improve mortality prediction. Patients with the first episode of SBP were included. Prognostic values for mortality were assessed using AUROC analysis. A novel prediction model was developed and validated. In total, 327 SBP patients were analyzed, with HBV infection as the main etiologies. MELD 3.0 demonstrated the highest AUROC among the traditional models. The novel model, incorporating HRS, exhibited superior predictive accuracy for in-hospital in all patients and 3-month mortality in HBV-cirrhosis, with AUROC values of 0.827 and 0.813 respectively, surpassing 0.8. MELD 3.0 score outperformed the CTP score and showed a non-significant improvement compared to other MELD-based scores, while the novel SBP model demonstrated impressive accuracy. Internal validation and an HBV-related cirrhosis subgroup sensitivity analysis supported these findings, highlighting the need for a specific prognostic model for SBP and the importance of preventing HRS development to improve SBP prognosis.

Prediction of In-Hospital Mortality in Spontaneous Bacterial Peritonitis Patients with Advanced Liver Disease

Introduction: Bacterial infections are known reason for morbidity and mortality in hospitalized patients with cirrhosis among which Spontaneous bacterial peritonitis (SBP) is most common, accounts for around 20% to 30% mortality rate. Objective: To evaluate the frequency of in-hospital mortality in SBP patients. Study Design: Descriptive case series. Setting: Asian Institute of Medical Sciences Hospital Hyderabad. Duration: From 1st January 2019 to 30th June 2019. Material and Methods: Adult patients diagnosed to have spontaneous bacterial peritonitis and followed for outcome. Results: 223 patients of spontaneous bacterial peritonitis I,e 165 (74%) male and 58 (26%) female fulfilling the inclusion criteria were enrolled in study. Mean age obtained was 47.56 ± 13.069 years and Hepatitis C with most common etiology for CLD was 128 (57.4%) followed by Hepatitis B 26 (11.7%), Hepatitis B + D 30 (13.5 %) and Alcohol 8 (3.6 %). Hepatocellular carcinoma in 70 (31.4 %) only. CTP (Child-Turcot-Pugh) score and MELD (Model for End-stage Liver Disease) score used to access stage of cirrhosis. 38 (17 %) patients with CTP class B and 185 (83 %) with CTP class C. The mean MELD score of all patients found to be 23.09 ± 15.686. Among 223 patients, in-hospital mortality was observed in 61 (27.4%), 115 (51.6%) were discharged with improvement and rest 47 (21.1%) discharged with no improvement. Practical Implication: This study's findings underscore the need for early detection and aggressive management of Spontaneous Bacterial Peritonitis in patients with advanced liver disease, especially those with CTP Class C and high MELD scores, to reduce the high in-hospital mortality rate. Conclusion: Significantly high in-hospital mortality was found to be associated with SBP, with CTP Class C, High MELD Score, increased creatinine, bilirubin, PT, INR and decreased albumin especially in females. Keywords: Cirrhosis; In-hospital mortality; Spontaneous bacterial peritonitis

Clinical Characteristics and Early Diagnosis of Spontaneous Fungal Peritonitis/Fungiascites in Hospitalized Cirrhotic Patients with Ascites: A Case-Control Study.

Spontaneous fungal peritonitis (SFP) and fungiascites is less well-recognized and described in patients with liver cirrhosis. The aims of this study were to determine the clinical characteristics, prognosis, and risk factors of cirrhotic patients with SFP/fungiascites and to improve early differential diagnosis with spontaneous bacterial peritonitis (SBP). This was a retrospective case-control study of 54 cases of spontaneous peritonitis in cirrhotic patients (52 SFP and 2 fungiascites) with fungus-positive ascitic culture. Fifty-four SBP cirrhotic patients with bacteria-positive ascitic culture were randomly enrolled as a control group. A nomogram was developed for the early differential diagnosis of SFP and fungiascites. Hospital-acquired infection was the main cause of SFP/fungiascites. Of the 54 SFP/fungiascites patients, 31 (57.41%) patients carried on with the antifungal treatment, which seemed to improve short-term (30-days) mortality but not long-term mortality. Septic shock and HCC were independent predictors of high 30-day mortality in SFP/fungiascites patients. We constructed a predictive nomogram model that included AKI/HRS, fever, (1,3)-β-D-glucan, and hospital-acquired infection markers for early differential diagnosis of SFP/fungiascites in cirrhotic patients with ascites from SBP, and the diagnostic performance was favorable, with an AUC of 0.930 (95% CI: 0.874-0.985). SFP/fungiascites was associated with high mortality. The nomogram established in this article is a useful tool for identifying SFP/fungiascites in SBP patients early. For patients with strongly suspected or confirmed SFP/fungiascites, timely antifungal therapy should be administered.

MICROBIOLOGICAL PROFILE OF SPONTANEOUS BACTERIAL PERITONITIS IN PATIENTS WITH CIRRHOSIS OF LIVER IN SOUTHERN ASSAM.

Liver cirrhosis is a common disorder which can have a wide range of aetiologies. Anatomically, it is characterised as a widespread process of nodule formation and fibrosis in the liver. Without any obvious intra-abdominal source of infection, spontaneous bacterial peritonitis (SBP) is characterised by infection of the previously sterile ascitic fluid (AF). SBP is a primary cause of death in decompensated liver disease and requires quick identification and care. In recent years, Assam has seen an increase in the prevalence of alcoholic liver disease and associated complications. Aims and Objectives: This study was undertaken with an idea to evaluate the significance of AF analysis with AF culture and sensitivity to determine microbiological profile and prognosis in cirrhotic patients with SBP in this region. Materials and Methods: Patients admitted with liver cirrhosis with ascites were studied during the period from June 2021 to May 2022. All patients included in the study were confirmed liver cirrhosis by ultrasound. Basic demographics, symptoms and clinical signs of patients were recorded. Patients with the history of antibiotic use within last 3 days or any intraabdominal source of infection were excluded. Diagnostic paracentesis was done for ascitic fluid detailed report and culture. Out of 100 SBP patients, 60 (60%) had culture negative neutrocytic ascites and 40 (40%) had Results: bacterascites. Fever, abdominal tenderness and constipation were common in SBP patients. Ascitic fluid culture was positive in 26 (52%) patients. E. coli (28%) was the predominant pathogen followed by Klebsiella species (8%), Staphylococcus aureus (2%) and acetinobacter (2%). 33 (82.5%) cases showed sensitivity to cefotaxim. In rest 17.5% cases, organism is mildly sensitive or resistant to 3rd generation cephalosporins

Executive Summary: Guidelines for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU: Neurology, Peri-Transplant Medicine, Infectious Disease, and Gastroenterology Considerations.

Executive Summary: Guidelines for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU: Neurology, Peri-Transplant Medicine, Infectious Disease, and Gastroenterology Considerations.

Non-Invasive Methods for the Prediction of Spontaneous Bacterial Peritonitis in Patients with Cirrhosis

Spontaneous bacterial peritonitis (SBP) is a potentially fatal complication in patients with liver cirrhosis. Early diagnosis and prompt treatment of SBP are vital to shorten hospital stays and reduce mortality. According to society guidelines, patients with cirrhosis and ascites who are admitted to the hospital should have diagnostic paracentesis. However, for various reasons, paracentesis may be delayed or not performed. Therefore, recent research has focused on identifying non-invasive parameters useful in SBP prediction which require urgent antibiotic therapy if rapid and secure paracentesis is not possible or there is insufficient experience with this method. In this review, we discuss the non-invasive methods available to predict SBP.

Low Serum Zinc and Spontaneous Bacterial Peritonitis in Patients with HCV-Related Liver Cirrhosis

Low Serum Zinc and Spontaneous Bacterial Peritonitis in Patients with HCV-Related Liver Cirrhosis

Prognostic Value of Ascitic Neutrophil Gelatinase-Associated Lipocalin in Decompensated Liver Cirrhosis with Spontaneous Bacterial Peritonitis Patients

Prognostic Value of Ascitic Neutrophil Gelatinase-Associated Lipocalin in Decompensated Liver Cirrhosis with Spontaneous Bacterial Peritonitis Patients