Long-Term Prophylaxis of Spontaneous Bacterial Peritonitis in Patients with Cirrhosis

2005 ◽  
Vol 39 (5) ◽  
pp. 908-912 ◽  
Author(s):  
Lawrence A Frazee ◽  
Antonio E Marinos ◽  
Amy M Rybarczyk ◽  
Scott A Fulton
Keyword(s):  
Ascitic Fluid ◽  
Spontaneous Bacterial Peritonitis ◽  
English Language ◽  
Antimicrobial Prophylaxis ◽  
Secondary Prophylaxis ◽  
Data Synthesis ◽  
Bacterial Peritonitis ◽  
Search Terms ◽  
Bibliographic Search

OBJECTIVE: To review the literature regarding long-term prophylaxis of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis. DATA SOURCES: A MEDLINE (1967–September 2004) and bibliographic search of the English-language literature was conducted using the search terms spontaneous bacterial peritonitis, cirrhosis, antimicrobial, and prophylaxis. DATA SYNTHESIS: Long-term antimicrobial prophylaxis has been shown to decrease recurrent SBP in cirrhotics with a prior episode. Prophylaxis in patients with low ascitic fluid protein has also been shown to reduce the incidence of SBP; however, studies are too in-homogeneous to identify subgroups that benefit the most. CONCLUSIONS: Long-term antimicrobial therapy should be considered for secondary prophylaxis of SBP. Studies should be done to confirm this benefit and identify subsets of patients with low ascitic fluid protein who clearly benefit.

scholarly journals Spontaneous Bacterial Peritonitis among Cirrhotic Patients: Prevalence, Clinical Characteristics, and Outcomes

2021 ◽  
Vol 11 (1) ◽  
pp. 227
Author(s):  
Naim Abu-Freha ◽  
Tal Michael ◽  
Liat Poupko ◽  
Asia Estis-Deaton ◽  
Muhammad Aasla ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ascitic Fluid ◽  
Spontaneous Bacterial Peritonitis ◽  
Cox Regression ◽  
Positive Culture ◽  
Multidrug Resistant ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients ◽  
Escherichia Coli Bacteria

(1) Background: Spontaneous bacterial peritonitis (SBP) is a feared complication of liver cirrhosis. We investigated the prevalence of SBP, positive ascitic fluid cultures, and risk factors for mortality. (2) Methods: A retrospective analysis of all patients with cirrhosis hospitalized or in follow-up in a single center between 1996 and 2020. The clinical data, long-term complications, and mortality of SBP patients were compared with those of non-SBP patients. Ascitic fluid positive culture was compared with those without growth. (3) Results: We included 1035 cirrhotic patients, of which 173 (16.7%) developed SBP. Ascitic fluid culture growth was found in 47.4% of the SBP cases, with Escherichia coli bacteria detected in 38%, 24.4% grew ESBL-producing bacteria, and 14.5% displayed multidrug resistance. In a Cox regression model, SBP, male sex, prolonged INR at diagnosis, and hepatocellular carcinoma were found to be risk factors for mortality in cirrhotic patients. The long-term all-cause mortality was 60% in non-SBP and 90% in SBP patients. (4) Conclusions: Only a minority of cirrhotic patients developed SBP, 47.4% of which had positive ascitic fluid cultures with high antibiotic resistance. Growth of ESBL and multidrug resistant organisms is becoming more frequent in the clinical setting, reaching SBP mortality of 90%.

Treatment of Spontaneous Bacterial Peritonitis

2015 ◽  
Vol 33 (4) ◽  
pp. 582-585 ◽  
Author(s):  
Francesco Salerno ◽  
Vincenzo La Mura
Keyword(s):  
Renal Failure ◽  
Antibiotic Therapy ◽  
Ascitic Fluid ◽  
Spontaneous Bacterial Peritonitis ◽  
Hepatorenal Syndrome ◽  
Refractory Ascites ◽  
Bacterial Peritonitis ◽  
Risk Of Death ◽  
Tract Infections

Spontaneous bacterial peritonitis (SBP) is an infection of patients with cirrhosis and ascites. This peculiarity is due to the frequent intestinal translocation that allows bacteria to cross the intestinal barrier, colonizing the ascitic fluid. In cirrhosis, SBP is inferior only to urinary tract infections. It is prevalently sustained by Gram-negative bacteria such as Escherichia coli and Klebsiella. Risk factors for developing SBP are advanced age, refractory ascites, variceal bleeding, renal failure, low albumin levels (below 2.5 g/ml), bilirubin over 4 mg/dl, Child-Pugh class C and a previous diagnosis of SBP. Thus, this is an indication for a long-term antibiotic prophylaxis with norfloxacin. Renal failure - especially the hepatorenal syndrome - complicates SBP in about 20% of cases independently of the efficacy of the antibiotic therapy. The mortality of these patients is about 90%. Infusion of albumin significantly reduces the incidence of hepatorenal syndrome and consequently the risk of death. Long-term quinolonic prophylaxis as well as increased antibiotic therapies are causing the emergence of multidrug-resistant agents as frequent causes of SBP. In such cases, the antibiotic sensitivity to quinolones is low, and European recommendations suggest a second-line antibiotic therapy, including meropenem or piperacillin plus tazobactam. Collection of blood, urine and ascitic fluid for cultures is important for bacterial recognition, possibly before starting an empirical antibiotic therapy. Indeed, the probability of positive cultures rapidly vanishes when they are performed during already implemented antibiotic administration. It is important to know that a failure of the first-line therapy is associated with an increased probability of death.

SAT-009-Pharmacokinetics of ertapenem in plasma and ascitic fluid in cirrhotic patients with spontaneous bacterial peritonitis

2019 ◽  
Vol 70 (1) ◽  
pp. e628-e629
Author(s):  
Alberto Amador ◽  
Sara Cobo ◽  
Ariadna Padulles ◽  
Raul Rigo ◽  
Inmaculada Grau ◽  
...  
Keyword(s):  
Ascitic Fluid ◽  
Spontaneous Bacterial Peritonitis ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients

Intravenous albumin for spontaneous bacterial peritonitis and renal dysfunction in patients with cirrhosis-short review

2021 ◽  
Vol 5 (1) ◽  
pp. 01-03
Author(s):  
Marilena Stoian
Keyword(s):  
Renal Dysfunction ◽  
Spontaneous Bacterial Peritonitis ◽  
Cost Effective ◽  
Short Review ◽  
Decompensated Cirrhosis ◽  
Optimal Dosage ◽  
Bacterial Peritonitis ◽  
Beneficial Effects ◽  
Albumin Administration

Current clinical guidelines for albumin use in decompensated cirrhosis recommend the use of intravenous albumin infusions for management of ascites-related symptoms and paracentesis (removal of ascitic fluid) and for the management of spontaneous bacterial peritonitis (SBP), renal dysfunction and variceal bleeding. Routine albumin use is not recommended for the management of non-SBP infections. The aim of this review is to improve our understanding of the effects of albumin use in cirrhosis by reviewing the currently available and quantifying the effectiveness of intravenous albumin therapy to prevent specific cirrhosis complications, spontaneous bacterial peritonitis (SBP) and renal dysfunction. Long-term albumin administration to patients with decompensated cirrhosis improves survival, prevents complications, eases the management of ascites and reduces hospitalizations, thus being cost-effective. However, variant results indicate that further investigations are needed, aiming at confirming the beneficial effects of albumin, clarifying its optimal dosage and administration schedule and identify patients who would benefit most from long-term albumin administration.

Study of the role of ascitic fluid lactoferrin levels in the diagnosis of spontaneous bacterial peritonitis

2016 ◽  
Vol 29 (2) ◽  
pp. 464
Author(s):  
Ahmed Elmaaz ◽  
Atef Abulseoud ◽  
Hossam Ibrahim ◽  
Abdallah Essa ◽  
Enas Essa
Keyword(s):  
Ascitic Fluid ◽  
Spontaneous Bacterial Peritonitis ◽  
Bacterial Peritonitis
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