Treatment Of Spontaneous Bacterial Peritonitis 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.

Diagnostic model for spontaneous bacterial peritonitis in cirrhotic patients with ascites: a multicenter cohort study.

Spontaneous bacterial peritonitis (SBP) is a potentially life-threatening complication of cirrhotic ascites. Early diagnosis and treatment of SBP are essential to improve the survival rates and prognosis of patients. We aimed to identify the predictors of SBP to establish a new noninvasive early diagnostic tool. We screened 1618 patients who underwent paracentesis due to cirrhotic ascites between January 2017 and December 2018 in three hospitals. We evaluated the symptomatic, clinical, and laboratory parameters to identify the predictors of SBP. The primary diagnostic model was displayed as a nomogram. The model included abdominal pain, diarrhea, white blood cell count, neutrophil percentage, procalcitonin, C-reactive protein, lactate dehydrogenase, glucose, and Model for End-stage Liver Disease score. The model's diagnostic performance was good, with an AUC of 0.84 [95% confidence interval (CI), 0.81-0.87] in the training cohort. In the validation cohort, the diagnostic ability was also good, with AUCs of 0.87 (95% CI, 0.83-0.91) and 0.90 (95% CI, 0.87-0.94) for inner and outer validation queues, respectively. Moreover, the decision curve analysis confirmed the clinical utility of the nomogram model. In addition, we developed a Microsoft Excel calculation model to allow convenient adoption of the model in clinical practice. We developed good performing diagnostic models for SBP.

A Comparison of Oral and Intravenous Treatments in Managing Spontaneous Bacterial Peritonitis

Abstract Background: In cirrhotics, spontaneous bacterial peritonitis (SBP) is a potentially fatal illness that requires immediate antibiotic administration. This meta-analysis aimed to examine the effectiveness of IV and oral antibiotics in patients with SBP. Objectives: We compared the efficacy, safety, and cost-effectiveness of oral vs intravenous antibiotic therapy for the treatment of SBP using data from a retrospective cohort analysis. Study design: Retrospective cohort study Place and duration of study: A tertiary care Hospital in Peshawar from Jan 2022 to Jan 20243 Methods:At Tertiary Care Hospital Peshawar, a Retrospective Cohort Study was conducted including all patients diagnosed with SBP between January 2022 and January 2023. The patients were split into two groups based on the kind of antibiotics administered: Group B: patients in need of ampicillin, cephalosporines, or IV IV therapy; Group A: patients on oral antibiotics and ciprofloxacin/cotrimoxazole with norfloxacin (patient 44). Patients who were eighteen years of age or older were eligible for inclusion. Based on an ascitic PMN cell count of ≥250 cells/mm³ and positive bacterial cultures, they were diagnosed with hospital-acquired SBP. Secondary peritonitis and serious co-morbidities requiring non-study antibiotic therapy were excluded criteria. Results:Group B, which received metronidazole orally, had an 85% resolution rate and an in-hospital mortality rate.The highest mortality rate and length of hospital stay were determined to be 10% and 7 ±3 days, respectively. With a 90% resolution rate and a roughly 8% overall mortality rate, Group B only needed to stay in the hospital for 10 (±4) days. 15% recurrences in Group A Group B: 12 percent recurrences Conclusion:Oral antibiotics are statistically no different from IV in terms of mortality, length of stay, or other outcomes when used to treat SBP. The proven outcomes back up the introduction of oral therapy for individuals who qualify in order to improve adherence and save costs. Keywords: Oral antibiotics, Systematic & individual, IV therapy

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 > 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.

Clinical Findings, Bacterial Agents, and Antibiotic Resistance in Children with Spontaneous Peritonitis in Southern Iran: An Academic Tertiary Referral Center's Experience.

Spontaneous bacterial peritonitis (SBP) is a fatal complication of ascites fluid infection. The causes of SBP in children differ from those in adults, and these bacteria are frequently resistant to antibiotics. Therefore, this study investigated the clinical findings, bacterial etiology, and antimicrobial resistance in children with SBP. This study was conducted on all new pediatric ascites patients, who were admitted to the Department of Pediatric Gastroenterology, Namazi Hospital, affiliated with Shiraz University of Medical Sciences (Shiraz, Iran) from 2021 to 2022. Required data such as demographic information, and clinical information such as complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Gram staining, blood culture by Automated Blood Culture System (BACTEC), and antibiogram of ascites fluids by disc diffusion method were all collected. Finally, the data were statistically analyzed using SPSS Software (version 26). Besides, the t test, Fisher's exact, Mann-Whitney, and Chi square tests were used for data analysis. In all tests, P≤0.05 was considered statistically significant. The present study examined 62 children with ascites of which 18 (29%) had SBP. The median (IQR) age was 2.5 (8.1) years. Thirty-four (54.8%) of the participants were girls. Abdominal pain was the most common clinical manifestation in patients (54%), and there was a significant association between abdominal pain and SBP (P=0.02). In 12 positive ascites fluid cultures, coagulase-negative staphylococci had the highest frequency (25%), followed by Escherichia coli (16.7%). Third-generation cephalosporins had a 25% sensitivity in the total positive cultures. This sensitivity was 33.3% for Gram-negative cultures and 16.6% for Gram-positive cultures. Although third-generation cephalosporins are recommended as the primary antibiotic for the empirical treatment of SBP, the present study found high bacterial resistance. Finally, empirical therapy should be tailored to each region's bacterial resistance features.

Cost-effectiveness of albumin in the treatment of decompensated cirrhosis in resource-limited healthcare settings.

Human albumin (HA) is an effective adjuvant treatment for patients with cirrhosis developing spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS) and ascites requiring large-volume paracentesis (LVP). However, cost remains a barrier to use, particularly in resource-limited settings. This study aims to assess the cost-effectiveness of HA in patients with cirrhosis with SBP, HRS or ascites requiring LVP in the Indonesian healthcare system as a representative of a resource-limited setting. Three decision-tree models were developed to assess the cost-effectiveness of (1) antibiotics and HA versus antibiotics alone in patients with SBP, (2) terlipressin and HA versus terlipressin alone in patients with HRS, and (3) LVP and HA versus LVP and gelatine for patients with ascites. Clinical utility and economic inputs were pooled from the available literature. Time horizon was 3 months. Outcomes were expressed as incremental cost-effectiveness ratios (ICER) reported as 2021 IDR per quality-adjusted life year (QALY) (exchange rate June 30, 2021: 1 EUR = 17,245 IDR). Willingness-to-pay thresholds considered were: three times the GDP per capita (199,355,561 IDR/QALY; 11,560 EUR/QALY) and one time the GDP per capita (66,451,854 IDR/QALY; 3853 EUR/QALY). The ICER for antibiotics and HA (versus antibiotics alone) for SBP was 80,562,652 IDR per QALY gained (4672 EUR/QALY). The ICER for terlipressin and HA (versus terlipressin) for HRS was 23,085,004 IDR per QALY gained (1339 EUR/QALY). The ICER for LVP and HA versus LVP and gelatine was 24,569,827 IDR per QALY gained (1425 EUR/QALY). Adjunctive HA may be a cost-effective treatment for SBP, HRS and LVP in resource-limited settings.

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.

SPONTANEOUS BACTERIAL PERITONITIS

Spontaneous bacterial peritonitis (SBP) is an infection of ascitic fluid, posing a severe complication in patients with portal hypertension (PH). Hospital mortality rates are exceedingly high, sometimes surpassing 85%. Only timely diagnosis and treatment can mitigate mortality and morbidity levels. Purpose. Through literature analysis and review, demonstrate the necessity, appropriateness, and efficacy of SBP treatment in patients with decompensated portal hypertension. Additionally, highlight the potential development of ascites and subsequent infections, which may not always be linked to liver cirrhosis. Materials and methods. This article conducts a literature review and assesses recommendations, findings from randomized controlled trials, meta-analyses, and other review articles published in databases such as PubMed, Scopus, Web of Science, and Google Scholar between 2000 and 2023. Outcome. Diagnostic paracentesis is recommended for all ascites patients requiring emergency care or hospitalization to ascertain SBP presence. Accurate differentiation between SBP and secondary bacterial peritonitis is crucial, as treatment approaches differ for each condition. Conclusions. Standard SBP treatment entails promptly administering broad-spectrum antibiotics, considering the potential for community-acquired or nosocomial SBP, and factoring in microbial antibiotic resistance. Given SBP's annual mortality rate surpassing 50%, liver transplantation is recommended for SBP survivors.

Diagnostic evaluation of leukocyte esterase reagent strip in bedside rapid diagnosis of spontaneous bacterial peritonitis in cirrhotic patients

Background: Spontaneous bacterial peritonitis (SBP) is the most common and serious infection of liver cirrhosis patients with ascites. If not intervened with early antibiotic treatment leads to high morbidity and mortality. Thus, early diagnosis and treatment of SBP are needed for survival. Leukocyte esterase reagent can aid in early diagnosis. Aims and Objectives: This study aimed to assess the diagnostic accuracy of the leukocyte esterase dipstick test for the diagnosis of SBP in resource poor settings. Materials and Methods: This cross-sectional study was conducted during August 2018–January 2019 on patients with cirrhotic liver disease and ascites in a tertiary care medical college hospital, Puducherry. All patients underwent abdominal paracentesis, and ascitic fluid was subjected to cell counts, biochemistry tests, culture, and leukocyte esterase test (Multistrix SG8- Seimens) at 120 s and graded with five levels. Grade 3 was positive (125 polymorphonuclear leukocytes [PMNL]/mL) and grade 4 (&lt;500/mL), which exceeds the threshold for SBP (&lt;250 PMNL/mL). Sensitivity, specificity, positive, and negative predictive value (PPV and NPV) was calculated. Results: A total of 50 ascitic fluids were analyzed. Nine out of 50 (18%), 16 (32%), and 4 (8%) were positive for cell count method, Leucocyte esterase reagent (LER) test and culture, respectively. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy for LER test were 6.25%, 91.18%, 25%, 67.39%, and 64%, respectively. Conclusion: The LER strip test is useful for SBP diagnosis in an emergency and resource poor setting. It provides good diagnostic accuracy and high NPV and it is cost effective and better bedside tool for SBP diagnosis.

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.

Gut Microbiota and Infectious Complications in Advanced Chronic Liver Disease: Focus on Spontaneous Bacterial Peritonitis.

Liver cirrhosis is a chronic disease that can be complicated by episodes of decompensation such as variceal bleeding, hepatic encephalopathy, ascites, and jaundice, with subsequent increased mortality. Infections are also among the most common complications in cirrhotic patients, mostly due to a defect in immunosurveillance. Among them, one of the most frequent is spontaneous bacterial peritonitis (SBP), defined as the primary infection of ascitic fluid without other abdominal foci. SBP is mainly induced by Gram-negative bacteria living in the intestinal tract, and translocating through the intestinal barrier, which in cirrhotic patients is defective and more permeable. Moreover, in cirrhotic patients, the intestinal microbiota shows an altered composition, poor in beneficial elements and enriched in potentially pathogenic ones. This condition further promotes the development of leaky gut and increases the risk of SBP. The first-line treatment of SBP is antibiotic therapy; however, the antibiotics used have a broad spectrum of action and may adversely affect the composition of the gut microbiota, worsening dysbiosis. For this reason, the future goal is to use new therapeutic agents that act primarily on the gut microbiota, selectively modulating it, or on the intestinal barrier, reducing its permeability. In this review, we aim to describe the reciprocal relationship between gut microbiota and SBP, focusing on pathogenetic aspects but also on new future therapies.

Comparative Analysis of Intravenous Ceftriaxone and Ciprofloxacin for the Treatment of Bacterial Peritonitis in Liver Cirrhosis

Objective: This research aimed to evaluate the relative benefits of intravenous ciprofloxacin and ceftriaxone for the treatment of bacterial peritonitis in cirrhotic liver patients. Study Design: Randomized control trial Place and Duration: Department of Gastroenterology, Shaikh Zayed Hospital Lahore in the period from March, 2022 to August, 2022. Methods: Total 130 patients of bacterial peritonitis in liver cirrhosis were included. Patients were undergone for abdomen ultrasound to diagnose liver cirrhosis. Following the acquisition of written informed consent, participants' personal information (such as age, sex, and residence) was meticulously documented. Patients were equally divided in two groups. Group I received intravenous ceftriaxone 1g 12 hourly among 65 patients and 65 cases of group II received ciprofloxacin 200mg 12 hourly for 6 days. Effectiveness among both groups were assessed. Results: There were 44 (67.7%) males and 21 (32.3%) females in group I and in group II 52 (80%) males and 13 (20%) females. Patients mean age in group I was 39.10±6.29 years and in group II mean age was 41.7±3.50 years. We found that majority of the cases were from urban areas 37 (56.9%) in group I and 39 (60%) cases in group II. Frequency of effectiveness in group I was 49 (75.4%) and in group II efficacy found in 47 (72.3%) cases. Post-treatment complications in group I was 7 (10.8%) and in group II found in 6 (9.2%) cases. Satisfaction rate among patients was almost equal 46 (70.8%) and 45 (62.9%) in group I and II. Conclusion: The findings of this research indicate that the administration of ciprofloxacin intravenously is just as effective as the administration of ceftriaxone intravenously for the treatment of spontaneous bacterial peritonitis in cirrhotic cases.

Diagnostic Validity of Leucocyte Esterase Dipstick Tests for Spontaneous Bacterial Peritonitis in Patients with Cirrhosis

Background: One of the worst sequelae of cirrhosis and ascites is spontaneous bacterial peritonitis (SBP). Early detection and treatment of SBP are therefore essential for survival because this complication is linked to a high death risk if antibiotics are not administered promptly. Leukocyte esterase dipstick testing can identify the SBP quickly. Objective: To evaluate the diagnostic accuracy of leucocyte esterase dipstick test for the detection of spontaneous bacterial peritonitis taking ascitic fluid neutrophil count as gold standard. Study Design: Cross Sectional Study Settings: Department of Gastroenterology, Lady Reading Hospital, Peshawar Study Duration: This study was conducted from 1st July 2021 till 30th June 2022 Materials and Methods: Two samples (10cc each) of ascitic fluid aspirate were obtained from patients with cirrhosis on admission to the hospital, presenting with ascites, fever and abdominal pain. Bedside leucocyte esterase dipstick test was performed on one sample and the other was sent to hospital laboratory for ascitic fluid analysis for neutrophil count. The results of both modalities were compared diagnostic accuracy which was recorded in terms of sensitivity, specificity, positive predictive value and negative predictive. Results: Mean age of the patients was 46.68 ± 10.239 years. A total of 170 patients were enrolled. Age of the patients ranged from 18 to 75 years. Male patients were 113 (66.5%) while 57 patients (33.5%) were female. Hepatitis C was the leading cause of cirrhosis observed in 89 patients (52.4%). The sensitivity, specificity, positive and negative predictive value of leucocyte esterase dipstick test observed were 89.7%, 96.2%, 87.5% and 96.9% respectively. Conclusion: Leucocyte esterase dipstick test is a convenient, inexpensive and rapid diagnostic modality for SBP with better diagnostic accuracy. Keywords: Spontaneous Bacterial Peritonitis, Leucocyte Esterase Dipstick test, Diagnostic Accuracy.

STUDY OF THE MICROBIOLOGICAL PROFILE OF SPONTANEOUS BACTERIAL PERITONITIS IN PATIENTS OF CIRRHOSIS OF LIVER WITH ASCITIS

Background: Cirrhosis is a chronic disease of the liver in which diffuse destruction and regeneration of hepatic parenchymal cells occur, with diffuse increase in connective tissue, leading to disorganisation of the lobular architecture1. Spontaneous Bacterial Peritonitis is a frequent infectious complication in patients with cirrhosis and ascites. The most common gram negative bacteria isolated from SBP patients with liver cirrhosis are E coli and Klebsiella spp, while the most common gram positive bacteria are staphylococcus spp, streptococci spp and enterococci 2. Early antibiotic treatment of spontaneous bacterial peritonitis is critical. However, as the landscape of microbiological resistance is continuously changing in recent times, with an increasing number of multidrug-resistant organisms, the current management of SBP is more challenging. Objective: To nd out the pathogens causing Spontaneous bacterial peritonitis and their antimicrobial susceptibility pattern. Materials and Methods:AHospital based prospective observational study was carried out on 109 patients diagnosed with liver cirrhosis and ascites, admitted in the department of General Medicine. Those patients that t the inclusion and exclusion criteria were chosen as participants and diagnostic abdominal paracentesis was done before the rst dose of antibiotic and ascitic uid was examined for cell count, neutrophil count, protein, gram stain, direct microscopy for fungus and bacterial culture and sensitivity. Results: The prevalence of SBP was 24.77%. E-Coli (38.48%) was the most common bacteria isolated followed by Klebsiella Aerogenes (15.38%), MRSA (15.38%), Acinetobacter Lwofi (7.69%), Klebsiella Pneumoniae (7.69%), Enterobacter Cloacae (7.69%) and Staphylococcus Aureus (7.69%). Out of 10 gram negative bacteria which were isolated, 3 (23.07%) isolates were XDR (Extensively drug resistant) bacteria and 2(15.38%) isolates were MDR (Multi drug resistant) bacteria.

Efficacy predictors of third-generation cephalosporins in treating spontaneous bacterial peritonitis.

Objective:Third-generation cephalosporins (3rd GCs) have recently become controversial as the first-line strategy for empirical spontaneous bacterial peritonitis (SBP) treatment. This study aimed to identify SBP treatment efficacy predictors of 3rd GCs.Methods:In this retrospective cohort study, 279 cirrhosis patients with SBP who received 3rd GC monotherapy for initial empirical treatment from 2013 to 2019 were included. Nonresponse was defined as a decreased ascites polymorphonuclear (PMN) count < 25% from baseline after 48 hours of antibacterial treatment. Multivariate regression analysis was used to identify efficacy predictors of 3rd GCs in treating SBP. Kaplan–Meier analysis was used to evaluate survival data.Results:The nonresponder group included 120 patients with no response, and the responder group included 159 patients with responses. The response rate to 3rd GCs was 57.0% among all patients. The common pathogens were Escherichia coli (40.6%), Staphylococcus (15.6%), Klebsiella pneumonia (12.5%), and Streptococcus (12.5%) in 32 ascites culture isolates. Nosocomial SBP (NSBP) (odds ratio [OR]: 2.371, 95% confidence interval [CI]: 1.323–4.249, P = .004), pneumonia (OR: 11.561, 95% CI: 1.876–71.257, P = .008), recurrent SBP (OR: 3.386, 95% CI: 1.804–6.357, P < .001), platelet count (≥113.5 × 109/L) (OR: 3.515, 95% CI: 1.973–6.263, P < .001), and ascites PMN count (≤0.760 × 109/L) (OR: 4.967, 95% CI: 2.553–9.663, P < .001) were independent predictors of nonresponse to 3rd GCs against SBP. Survival plot analysis at 30 days showed worse survival for the nonresponders (P = .003).Conclusion:NSBP, pneumonia, recurrent SBP, increased platelet count, and lower ascites PMN count were independent predictors of nonresponse to 3rd GC in treating SBP. Nonresponse to initial antibiotic treatment was associated with worse survival.

Spontaneous Bacterial Peritonitis in Decompensated Liver Cirrhosis—A Literature Review

Background: Spontaneous bacterial peritonitis (SBP) is defined as a bacterial infection of the ascitic fluid without a surgically treatable intra-abdominal infection source. SBP is a common, severe complication in cirrhosis patients with ascites, and if left untreated, in-hospital mortality may exceed 90%. However, the incidence of SBP has been lowered to approx. 20% through early diagnosis and antibiotic therapy. Clinical awareness, prompt diagnosis, and immediate treatment are advised when caring for these patients to reduce mortality and morbidity. Aim: To discuss important issues comprising types of SBP, pathogenesis, bacteriology, including the emergence of multidrug-resistant (MDR) microorganisms, prompt diagnosis, risk factors, prognosis, treatment strategies, as well as recurrence prevention through antibiotic prophylaxis until liver transplantation and future trends in treating and preventing SBP in detail. Methods: This article is a literature review and appraisal of guidelines, randomized controlled trials, meta-analyses, and other review articles found on PubMed from between 1977 and 2022. Results: There are three types of SBP. Bacterial translocation from GI tract is the most common source of SBP. Therefore, two thirds of SBP cases were caused by Gram-negative bacilli, of which Escherichia coli is the most frequently isolated pathogen. However, a trend of Gram-positive cocci associated SBP has been demonstrated in recent years, possibly related to more invasive procedures and long-term quinolone prophylaxis. A diagnostic paracentesis should be performed in all patients with cirrhosis and ascites who require emergency room care or hospitalization, who demonstrate or report consistent signs/symptoms in order to confirm evidence of SBP. Distinguishing SBP from secondary bacterial peritonitis is essential because the conditions require different therapeutic strategies. The standard treatment for SBP is prompt broad-spectrum antibiotic administration and should be tailored according to community-acquired SBP, healthcare-associated or nosocomial SBP infections and local resistance profile. Albumin supplementation, especially in patients with renal impairment, is also beneficial. Selective intestinal decontamination is associated with a reduced risk of bacterial infection and mortality in high-risk group. Conclusions: The standard treatment for SBP is prompt broad-spectrum antibiotic administration and should be tailored according to community-acquired SBP, healthcare-associated or nosocomial SBP infections and local resistance profile. Since the one-year overall mortality rates for SBP range from 53.9 to 78%, liver transplantation should be seriously considered for SBP survivors who are good candidates for transplantation. Further development of non-antibiotic strategies based on pathogenic mechanisms are also urgently needed.

Comparative Analysis of Intravenous Ceftriaxone and Ciprofloxacin for the Treatment of Bacterial Peritonitis in Liver Cirrhosis

The Purpose of the current study to Evaluate the efficacy of intravenous ciprofloxacin with ceftriaxone for the treatment of bacterial peritonitis in patients of liver cirrhosis at PIMS Hospital Islamabad from January 2021 to June 2021 at Department of Medicine .A total of 260 patients of liver cirrhosis were selected for this study. Patients were randomly allocated in two groups (Group A and B). Patients aged 13 to 60 years of both genders with established liver cirrhosis, diagnosed on ultrasound abdomen were included in this study. Patients with hemorrhagic or malignant ascites, peritonitis, tuberculosis peritonitis, hepatocellular carcinoma and diabetes mellitus were excluded from study. In group A, 130 patients were given intravenous ciprofloxacin 200mg 12 hourly and in group B 130 patients on ceftriaxone 1g 12 hourly. Treatment was given for 5 days and efficacy of treatment was determined by means of evaluating clinical symptoms. The mean age of the patients in group A was 43.4±10.4 years and in group B was 44.2±10.2 years. In group A there were 90(70%) patients and 95(73.3%) patients in group B in whom spontaneous bacterial peritonitis was settled down. The Result of the current study suggest that Intravenous is as effective as ceftriaxone in the treatment of spontaneous bacterial peritonitis in cirrhotic patients. Keywords: liver cirrhosis, ciprofloxacin, bacterial peritonitis, ceftriaxone

Compare the Efficacy of Oral Versus Intravenous Medicine in Treatment of Spontaneous Bacterial Peritonitis

Objective: The purpose of this study is to determine whether or not oral medication is more effective than intravenous medication in the treatment of peritonitis caused by bacteria. Study Design:Comparative study Place and Duration: Department of Internal Medicine Gangaram hospital Lahore and Medical ward, THQ Hospital Dargai, from October, 2021 to March, 2022. Methods: There were 102 cases of both genders having spontaneous bacterial peritonitis because of cirrhosis were included. Included patients were aged between 18-60 years.After taking informed written consent, detailed demographics of enrolled cases were recorded. Patients were equally divided in two groups. Group I received intravenous antibiotic in 51 patients and group II received oral antibiotics in 51 patients. Post-treatment outcomes were compared among both groups. SPSS 22.0 was used to analyze all data. Results: We found that effectiveness in group I was higher 47 (92.2%) as compared to group II44 (86.3%) but not a significant difference observed. Frequency of mortality in group II was 4 (7.8%) and in group I 3 (5.9%). Diarrhea, nausea, vomiting, rashes and gastrointestinal distress were the most common adverse effects in both groups. Conclusion: We concluded in this study that the use of antibiotics orally and intravenously for SBP treatment was affective equally. There was no any significant difference observed in both procedures. Keywords: Cirrhosis, Oral Antibiotics, Intravenous Antibiotics, SBP, Efficacy

A comparative study on nosocomial and community-acquired spontaneous bacterial peritonitis in patients with liver cirrhosis at a university hospital.

The serious nature of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and the need for timely effective empirical antibiotic therapy in the context of the global surge of antimicrobial resistance and changing epidemiology necessitate a periodic review of the local epidemiologic features of the disease. The aim of the study is to investigate the differences in bacterial profile and antibiotic resistance between nosocomial and community-acquired SBP in patients with liver cirrhosis to guide empirical antibiotic choices for better outcomes. This cross-sectional study included 95 ascitic cirrhotic patients diagnosed with SBP. According to the setting in which the infection was acquired, the patients were divided into two groups: nosocomial and community-acquired SBP. The bacterial profile and rates of multidrug resistance (MDR) phenotype and the extended-spectrum β-lactamase (ESBL) production among Gram-negative isolates in both groups were compared. Escherichia coli was the most frequently isolated bacteria (60% of all isolates) followed by Klebsiella pneumoniae (11.4%). Gram-positive bacteria were only isolated from nosocomial SBP cases; the most common was Staphylococcus aureus (11.4%) followed by coagulase-negative staphylococci (5.7%). High rates of resistance to third-generation cephalosporins, the first-line empirical treatment of SBP, were detected (76.6-100% in nosocomial isolates and 25-87% in community isolates). Carbapenems, amikacin and gentamycin showed good activity against Gram-negative bacilli in both nosocomial and community-acquired isolates. MDR bacteria, including ESBL-producing Enterobacteriaceae, were significantly associated with nosocomial SBP. The significant increase in MDR phenotype and ESBL production among nosocomial isolates necessitates a change in the initial empirical therapy for nosocomial SBP and carbapenems seem good alternatives.

Comparative Study between the Efficacy of Oral Gemifloxacin and Intravenous Cefotaxime in Treatment of Spontaneous Bacterial Peritonitis

Background and Aims: Spontaneous bacterial peritonitis (SBP) is defined as a bacterial infection of the ascitic fluid (AF) that arises in individuals without an intra-abdominal source of infection that is surgically curable. SBP is a unique complication in cases with cirrhosis-linked ascites, and it can be so subtle that it is only reported by chance when paracentesis is done. SBP is handled with any of a variety of cephalosporins, such as cefotaxime or quinolones, such as Gemifloxacin. The aim was comparing the effect of oral Gemifloxacin versus intravenous cefotaxime in 60 individuals with cirrhosis who had SBP.&#x0D; Patients and Methods: The randomized controlled research involved 60 cirrhotic ascitic individuals suffering from SBP admitted to Tropical Medicine Department, Tanta University Hospital. Two groups of patients were investigated: group I included 30 cirrhotic ascitic patient suffering from SBP treated with IV cefotaxime 2gm|8 hours for 7 days and group II included 30 cirrhotic ascetic patient suffering from SBP and treated with oral Gemifloxacin 320 mg once daily for 7 days.&#x0D; Results: No substantial difference was noted among both groups regarding age, sex, or symptoms, or in laboratory tests such as hemoglobin, total leukocytic count, platelet, serum bilirubin, ALT, AST, albumin, prothrombin activity, INR, creatinine, urea, sodium, and potassium. Also, the outcome was comparable in both groups as regarding the number of treated patients (p=0.781); 20 (66.67%) cases were cured in group I and 21 (70%) cases were cured in group II and in AF analysis after treatment. By using gram stain, gram –ve organism were the predominant in group I 23 (76.7%) and group II 24 (80%) while gram +ve was detected in 7 (23.3%) and 6 (20%) in group I and II respectively. Furthermore, no substantial difference was noted among both groups regarding treatment response based on culture prior to treatment.&#x0D; Conclusions: Our research is the first to focus on Gemifloxacin use in the management of SBP rather than in the prevention of SBP. Since these agents' relative effectiveness is identical, cost should be the deciding factor. In conclusion, our findings indicate that cefotaxime or Gemifloxacin can be used as a first-line therapy.