Spontaneous Bacterial Peritonitis In Patients Research Articles

Frequency of Asymptomatic Spontaneous Bacterial Peritonitis in Patients with Chronic Liver Disease and Ascites

Chronic liver disease (CLD) contributes significantly to morbidity and mortality around the world. In Pakistan, it is due mainly to infections of Hepatitis B and C. One of the complications of CLD, which is often important for such patients, involves an infection of spontaneous bacterial peritonitis. Asymptomatic spontaneous bacterial peritonitis commonly develops in asymptomatic patients with ascites and is therefore preventable when it develops early. This study will determine the incidence of asymptomatic SBP in patients with CLD and ascites, providing potentially valuable data to support screening protocols for early intervention and improved outcomes. It was a cross-sectional study carried out for six months in the Gastroenterology Department of Sheikh Zayed Hospital, Lahore. A total of 121 CLD patients with ascites, meeting particular inclusion criteria, were assessed. The cases were categorized as asymptomatic SBP if the cultures were positive with more than 10⁵ colonies or more than 250/mm³ polymorphonuclear cells, without fever, pain, or tenderness. The patients were stratified according to age, gender, and Child-Pugh classification. The data were analyzed using SPSS version 24, along with the Chi-square test for correlation between the Child-Pugh class and SBP.The proportion of asymptomatic SBP was at 14.8 % among 121 patients. The patients were older: 66.1%, were mostly more than 50 years old, with a fair sex distribution ratio of 52.1 females against 47.9 males. Patients classified into Child-Pugh Class C constituted the highest proportions of patients with SBP cases of 14.8 % and significant association at p=0.000. Asymptomatic SBP in 14.8% of the patients with CLD and ascites forms the justification for routine screening on hospital admission. Critical importance is placed on detecting asymptomatic SBP because this leads to earlier intervention and a potential reduction in the risk of major complications, particularly in patients classified as Child Class C. Keywords- Frequency, Asymptomatic, Spontaneous Bacterial Peritonitis, Patients Chronic Liver Disease, Ascites

FREQUENCY OF PIPERACILLIN/TAZOBACTAM RESISTANCE IN SPONTANEOUS BACTERIAL PERITONITIS PATIENTS

Spontaneous bacterial peritonitis (SBP) is a serious infection in patients with chronic liver disease, requiring prompt antibiotic therapy. Due to growing resistance to first-line antibiotics like ceftriaxone, piperacillin/tazobactam is often used as a second-line treatment. However, emerging resistance to piperacillin/tazobactam poses a significant clinical challenge. Identifying local resistance patterns is crucial for optimizing treatment, particularly in resource-limited settings like Peshawar, Pakistan. Objective: To determine the frequency of piperacillin/tazobactam resistance among patients with spontaneous bacterial peritonitis at a tertiary care hospital in Peshawar, Pakistan. Methods: This cross-sectional study was conducted over five months at Lady Reading Hospital, Peshawar from 18th April to 18th September. A total of 169 patients aged 16 to 75 years with SBP secondary to chronic liver disease were included using non-probability consecutive sampling. Demographic and clinical data were collected, and ascitic fluid samples were cultured to assess resistance to piperacillin/tazobactam. Data were analyzed using descriptive statistics and chi-square tests to examine associations. A p-value < 0.05 was considered statistically significant. Results: Piperacillin/tazobactam resistance was found in 9.5% (16/169) of SBP patients. Resistance was observed in 8.0% (7/88) of Escherichia coli isolates and 11.1% (9/81) of other bacterial isolates (p = 0.04). Resistance rates were slightly higher in the 46–75 age group (11.0%, 11/100) compared to the 16–45 age group (7.3%, 5/69). Male patients had a resistance rate of 10.2% (11/108), while female patients showed 8.2% (5/61). Conclusion: This study highlights significant resistance to piperacillin/tazobactam among SBP patients in Peshawar, particularly in non-E. coli bacteria. These findings underline the need for personalized antibiotic regimens and ongoing surveillance to address growing antimicrobial resistance in chronic liver disease patients.

Study for the Significance of Ascetic Fluid Lactoferrin in Diagnosis of Spontaneous Bacterial Peritonitis in Decompensated Liver Cirrhosis

Abstract Background Cirrhosis represents the inal common histological pathway for a wide variety of chronic liver diseases. Occurrence of ascites is the most common presentation of liver cirrhosis. Spontaneous bacterial peritonitis (SBP) is observed in 15–26% of patients hospitalized with ascites. SBP is deined as the infection of AF in the absence of a contiguous source of infection and/or an intra-abdominal inlammatory focus. An AF-polymorphonuclear (PMN) leukocyte count more than or equal to 250/mm irrespective of the AF culture result is universally accepted nowadays as the best surrogate marker for diagnosing SBP. Frequently, the results of the manual or automated PMN count do not reach the hands of the responsible medical personnel in a timely manner. Aim of the Work to use AF lactoferrin for the diagnosis of SBP and to identify a clinically useful marker that can be used for future development of an important clinical, economic, and time saving rapid bedside test for the diagnosis of SBP in cirrhotic ascites. Patients and Methods This study was conducted on 60 patients with decompensated chronic liver disease and ascites with and without spontaneous bacterial peritonitis admitted to Gastroenterology and Hepatology department inpatient and outpatient clinics at Ain Shams University Hospitals and labs, from April 2023 to September 2023. Results Females were affected more than males by SBP, SBP has higher incidence in elderly compared to control group No significant difference between studied groups regards to risk factors and Child class (p > 0.05). HCV infection was the main etiology of liver cirrhosis in both groups while HBV infection was much less common with no significant difference between studied groups (p > 0.05). Patients in SBP group showed positive reaction to CRP compared to control group with significant difference between them (p < 0.05). No statistical significant differences between studied groups regards to abdominal ultrasonographic indings (p > 0.05). Liver enzymes (ALT and AST) were higher in SBP patients compared to non SBP patients with signiicant difference between them (P < 0.05). SBP patients have higher TLC and lower MCV and platelets count compared to non SBP patients with signiicant difference between them (P < 0.05). No statistical signiicant difference between studied groups regards to INR, Hb and MCH values (p > 0.05). Conclusion Outcomes of our study provide evidence of the clinical usefulness of AF lactoferrin levels in patients with cirrhosis to differentiate those with and without SBP. It is important to note that the correlation of lactoferrin levels and inlammatory markers in blood samples and AF could be inluenced by lysis of PMN cells during transport to the laboratory, which could lead to a false negative result. Moreover, manual measurement of the AF and PMN count is operator dependent, which makes quality control difficult. Commercially available kits for the measurement ascetic luid lactoferrin could be used in a future development of qualitative bedside assay.

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.

Study of Serum Homocysteine Level in Cirrhotic Ascitic Patients as a New Diagnostic Marker for Spontaneous Bacterial Peritonitis

Abstract Background SBP is the commonest life-threatening infection encountered in cirrhotic patients with ascites. It accounts for more than half of all infections. The outpatient prevalence of SBP is 1.5–3.5% and exceeds 10% in hospitalized patients. The immune dysfunction in decompensated cirrhotic patients along with vulnerability of gut mucosa leading to translocation of bacteria and bacterial endotoxins from bowel lumen into ascitic fluid (AF) underlines the pathogenesis of SBP Objective This study is to assess the value and the accuracy of serum Homocysteine Level in cirrhotic ascitic patients as a new diagnostic marker for spontaneous bacterial peritonitis Patients and Methods This case control study was conducted on 60 cirrhotic patients recruited from the outpatient clinic and the ward of hepatology department of Ain Shams University Hospitals, during the period from January 2021 to August 2021 Results This study was conducted in Ain Shams University ward and outpatient clinic of the Hepatology department. The study included 60 cirrhotic patients who were divided into 2 groups Conclusion Serum homocysteine level is elevated in cirrhotic patients with SBP. Serum homocysteine value of > 15.73 μmol/l had a sensitivity of 85.93%, and specificity of 83.45% for diagnosis of SBP. Serum homocysteine is positively correlated with severity of liver disease.

Frequency of Asymptomatic Spontaneous Bacterial Peritonitis in Patients of Chronic Liver Disease with Ascites

Frequency of Asymptomatic Spontaneous Bacterial Peritonitis in Patients of Chronic Liver Disease with Ascites

Role of Systemic Immune Inflammation Index, Systemic Immune Response Index, Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Predicting Peritoneal Culture Positivity and Prognosis in Cases of Spontaneous Bacterial Peritonitis Admitted to the Emergency Department.

Background and Objectives: Spontaneous bacterial peritonitis (SBP) is a life-threatening disease that requires early diagnosis and treatment. It is known that a positive culture result for SBP, which is a common reason for admission to the emergency department, is related to the severity and prognosis of the disease. However, as it is not possible to determine the culture result in the early stage of the disease, different methods are required to predict prognosis in the emergency department. This study was conducted to evaluate the success of the SII, SIRI, NLR and PLR in predicting culture results, intensive care needs and mortality in patients with SBP admitted to the emergency department. Materials and Methods: This study was a retrospective, observational study. Patients with SBP who applied to the emergency department were included in this study. Pregnant women, patients with a malignancy, patients with another infection and patients with liver failure were excluded from this study. Data were analyzed in terms of culture results, the need for intensive care and mortality development. Analyses were performed using SPSS version 26. Results are presented with a 95% confidence interval. A p value less than 0.05 was considered statistically significant. Participant data were analyzed using the independent samples t-test or the Mann-Whitney U test based on normality, and ROC analyses were conducted to assess test accuracies and determine cut-off values. Results: A total of 275 patients were included in this study. Although the culture results of 183 patients were positive, 92 were negative. The SII, NLR and PLR were found to be significantly higher in culture-positive patients (p < 0.001, p = 0.013 and p = 0.002, respectively). The SII and NLR were found to be significantly higher in patients with high mortality (p < 0.001 and p = 0.017, respectively). Conclusions: This study showed that the SII, NLR and PLR may be useful in predicting culture positivity and prognosis in SBP patients in the emergency department.

Ascitic ENDOCAN as a Useful Marker in the Diagnosis of Spontaneous Bacterial Peritonitis

Abstract Background Spontaneous bacterial peritonitis (SBP) is a serious, recurrent, and life-threatening condition developing in cirrhotic patients with a high mortality rate. Its diagnosis is based on ascitic fluid polymorphonuclear leukocytes (PMNs) to be more than 250/μL. Endocan is a proteoglycan (PG) secreted by vascular endothelium, its serum level is elevated with an inflammatory or a malignant process. Aim of the Work to evaluate the potential role of ascitic fluid levels of endocan as an appropriate marker for prediction and early diagnosis of spontaneous bacterial peritonitis in patients with liver cirrhosis. Patients and Methods This was Prospective cohort study, was conducted in hepatology Unit of Ain Shams University Hospital over 100 patients with liver cirrhosis classified into two groups: (Non-SBP): included 50 patients of decompensated cirrhosis with sterile (non SBP) ascites, (SBP): included 50 Adult patients with liver cirrhosis and SBP, during a Period 6 months. All patients were subjected to: Full history taking, Clinical examination, Routine investigations, Radiology investigations, Determination of ascitic endocan levels by ELISA. Result The main results of the study revealed that: There was no statistically significant difference between the studied groups as regard personal data. There was a high statistically significant difference between the studied groups as regardsChild-Pugh score. There was no statistically significant difference between the studied groups as regard LFT. There was statistically significant difference between the studied groups as regard WBCs. There was statistically significant difference between the studied groups as regard INR. There was no statistically significant difference between the studied groups as regard creatinine. There was statistically significant difference between the studied groups as regard Ascetic endocan. Conclusion In conclusion, this study demonstrates that ascitic endocan level is an independent risk factor for SBP and has a high diagnostic value for detecting SBP in patients with decompensated cirrhosis.

Spontaneous bacterial peritonitis in patients with portal hypertension

Background. Spontaneous bacterial peritonitis (SBP) is a life-threatening infection in patients with portal hypertension (PH) and ascites. Its prevention and treatment are vital to improve the prognosis in decompensated PH. Alterations in gut microbiota, gut permeability, and systemic immune dysfunction are cornerstones in the development of SBP in patients with PH. This contributes to the translocation of bacteria from the intestinal lumen to the mesenteric lymph nodes, and then to the portal and systemic circulation from where the ascitic fluid can be colonized with the subsequent development of peritonitis. The purpose was to monitor the course of the disease and determine the possibility of correcting pathological factors of SBP such as bacterial contamination and volume of ascitic fluid, nature of bacterial contamination, increased intra-abdominal pressure, hypoalbuminemia, and to evaluate the role of antibacterial therapy, paracentesis in the treatment of patients with SBP in decompensated PG. Materials and methods. Examination and treatment of 242 patients with ascites who were admitted for emergency medical care were carried out. Diagnostic paracentesis was performed to examine ascitic fluid, which allowed to detect neutrophilia &gt; 250 cells in 1 mm3 in 194 (80.2 %) patients and indicated the presence of SBP. These patients made up the first group of observation. In the second group, there were 48 (19.8 %) patients with no clinical and laboratory signs of SBP at the time of hospitalization. Methodology of analysis of actual research material: to find a statistical difference between the distribution of nominal data of patients in this study, we used Pearson’s χ2 test. To establish the strength of the relationship between variables, we determined the polychoric correlation coefficient. When a statistically significant difference was detec-ted, a stratification analysis was performed with determination of the 95% confidence interval of the odds ratio (Clopper-Pearson method) and the risk ratio for the development of complications in PH. Results. Empiric antibacterial therapy, which was carried out from the moment of receiving information about SBP and began with the use of broad-spectrum antibiotics, was successful in 41 % of cases that was confirmed by repeated examination of ascitic fluid. In antibiotic resistance, determining the sensitivity of ascitic microflora led to a delay in an effective anti-inflammatory treatment and affected the results. In the first group, 39 (20.1 %) patients died, in the second group, 22 (50 %), total mortality was 25.2 %. Conclusions. Diagnostic paracentesis combined with the assessment of bacterial contamination of ascitic fluid, evaluation of intra-abdominal pressure, state of osmoregulation based on albumin concentration is a safe and informative method of diagnosing the severity of pathological process in patients with complicated PH. Treatment of SBP requires urgent care, both in terms of elimination of the infectious factor, and normalization of the disturbed mechanisms of reabsorption regulation by peritoneal and hepatorenal processes. High mortality in patients with SBP is due to the development of inflammation in the abdominal cavity against the background of progressive hepatorenal insufficiency and the inability to correct decompensated PH.

Ascitic Fluid Calprotectin as a Diagnostic Marker of Spontaneous Bacterial Peritonitis in Patients with Liver Cirrhosis

Ascitic Fluid Calprotectin as a Diagnostic Marker of Spontaneous Bacterial Peritonitis in Patients with Liver Cirrhosis

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.

Diabetes mellitus and the risk of spontaneous bacterial peritonitis in patients with liver cirrhosis: a systematic review and meta-analysis.

Spontaneous bacterial peritonitis (SBP) represents a critical and potentially lethal condition that typically develops in individuals with liver cirrhosis. This meta-analysis aimed to assess diabetes mellitus (DM) as a risk factor for SBP in liver cirrhotic patients. Following PRISMA guidelines, fifteen studies were included, for a total of 76 815 patients. The risk of bias was assessed using the Newcastle-Ottawa scale (NOS). We represented the results as risk ratios (RR) with the corresponding 95% confidence intervals (CI) using RevMan software. Additionally, we pooled the hazard ratios (HR) for developing SBP in patients with DM from the included studies. The meta-analysis shows a significantly increased risk of SBP in cirrhotic patients with DM (HR: 1.26; 95% CI [1.05-1.51], P=.01; HR: 1.70; 95% CI [1.32-2.18], P<.001). The study signifies that DM is an independent risk factor for SBP, emphasizing the need for targeted preventive measures in this specific population.

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