| Literature DB >> 27681894 |
Seongman Bae1, Taeeun Kim1, Min-Chul Kim1, Yong Pil Chong1, Sung-Han Kim1, Heungsup Sung2, Young-Suk Lim3, Sang-Oh Lee1, Mi-Na Kim2, Yang Soo Kim1, Jun Hee Woo1, Sang-Ho Choi4.
Abstract
Entities:
Year: 2016 PMID: 27681894 PMCID: PMC5039912 DOI: 10.1186/s12879-016-1828-0
Source DB: PubMed Journal: BMC Infect Dis ISSN: 1471-2334 Impact factor: 3.090
Demographic and baseline clinical characteristics of patients with spontaneous bacterial peritonitis
| Variable |
|
|
|
|---|---|---|---|
| Male sex | 26 (81.3) | 104 (81.3) | |
| Age, years (mean ± SD) | 55 ± 10.9 | 55 ± 11.7 | |
| SBP subtype | 0.03 | ||
| Definite SBPa | 26 (81.2) | 78 (60.9) | |
| Probable SBPb | 6 (18.8) | 50 (39.1) | |
| Place of acquisition | <0.001 | ||
| Community | 12 (37.5) | 98 (76.6) | |
| Hospital | 20 (62.5) | 30 (23.4) | |
| Concomitant hepatocellular carcinoma | 21 (65.6) | 48 (37.5) | 0.004 |
| Causes of liver cirrhosis | 0.79 | ||
| Hepatitis B virus | 21 (65.6) | 88 (68.8) | |
| Hepatitis C virus | 2 (6.2) | 13 (10.2) | |
| Alcoholism | 6 (18.8) | 19 (14.8) | |
| Others | 3 (9.4) | 8 (6.2) | |
| Child-Pugh class | 0.006 | ||
| A | 1 (3.1) | 0 (0) | |
| B | 10 (31.3) | 17 (13.3) | |
| C | 21 (65.6) | 111 (86.7) | |
| MELD score, median (IQR) | 19 (15–24) | 23 (18–29) | 0.03 |
| Underlying diseases | |||
| Diabetes mellitus | 9 (28.1) | 25 (19.5) | 0.29 |
| Alcoholism | 6 (18.8) | 23 (18.0) | 0.92 |
| Solid cancer (other than hepatoma) | 3 (9.4) | 4 (3.1) | 0.14 |
| Chronic kidney disease | 1 (3.1) | 2 (1.6) | 0.49 |
| Solid organ transplantation | 1 (3.1) | 0 (0) | 0.20 |
| Comorbid conditions | |||
| Transarterial chemoembolization (<30 days) | 4 (12.5) | 4 (3.1) | 0.052 |
| Endoscopic intervention (≤30 days) | 8 (25.0) | 7 (5.5) | 0.001 |
| Varix control | 5 | 6 | |
| ERCP | 3 | 1 | |
| Systemic anticancer chemotherapy (≤30 days) | 3 (9.4) | 0 (0) | 0.007 |
| Prior hospitalization (≤90 days) | 26 (81.2) | 74 (57.8) | 0.01 |
| Prior antimicrobial therapy (<30 days) | 19 (59.4) | 36 (28.1) | 0.001 |
Values are n (%) unless otherwise indicated. MELD model for end-stage liver disease, IQR interquartile range
ERCP endoscopic retrograde cholangiopancreatography
aAscites culture was positive
bAscites culture was negative, while blood culture was positive without any other primary focus
Clinical manifestations and laboratory findings of patients with spontaneous bacterial peritonitis by study group
| Variable |
|
|
|
|---|---|---|---|
| Initial clinical manifestation, n (%) | |||
| Abdominal pain | 23 (71.9) | 90 (70.3) | 0.86 |
| Fever | 24 (75.0) | 87 (68.0) | 0.44 |
| Hepatic encephalopathy | 6 (18.8) | 34 (26.6) | 0.36 |
| Septic shock | 5 (15.6) | 31 (24.2) | 0.30 |
| Upper gastrointestinal bleeding, n (%) | 9 (28.1) | 12 (9.4) | 0.005 |
| Variceal bleeding | 7 | 11 | |
| Ulcer bleeding | 1 | 1 | |
| Duodenal invasion of cancer | 1 | 0 | |
| Concomitant bacteremia, n (%) | 11 (34.4) | 87 (68.0) | 0.001 |
| Laboratory finding, median (IQR) | |||
| Serum WBC, cells/μL | 8,050 (5,125 − 13,200) | 6,450 (4,400 − 9,675) | 0.12 |
| Platelets, x 10/mL | 61 (44–104) | 62 (41–85) | 0.15 |
| C-reactive protein, mg/dL | 6.41 (2.1–7.9) | 3.06 (1.1–6.2) | 0.06 |
| Serum creatinine, mg/dL | 1.2 (0.9–1.5) | 1.2 (0.9–1.7) | 0.80 |
| Serum bilirubin, mg/dL | 3.8 (2.6–12.2) | 5.3 (3.5–10.3) | 0.79 |
| Ascites WBC, cells/μL | 6,160 (1,945–11,795) | 5,360 (2,690–11,960) | 0.45 |
| Ascites neutrophils, cells/μL | 5,058 (1,483–10,899) | 4,275 (2,092–10,771) | 0.46 |
| Ascites protein, mg/dL | 1.5 (1.0–2.5) | 1.0 (0.8–1.4) | 0.003 |
WBC white blood cells, IQR interquartile range
Antimicrobial susceptibility of isolates of Enterobacter species and Escherichia coli
| Antimicrobiala |
|
|
|
|---|---|---|---|
| Cefotaxime | 23/31 (74.2) | 106/125 (84.8) | 0.16 |
| Ceftazidime | 22/31 (71.0) | 106/125 (84.8) | 0.07 |
| Ceftriaxone | 22/31 (71.0) | 106/125 (84.8) | 0.07 |
| Third-generation cephalosporinsb | 22/31 (71.0) | 106/125 (84.8) | 0.07 |
| Cefepime | 25/29 (86.2) | 103/123 (83.7) | 1.00 |
| Ciprofloxacin | 25/31 (80.6) | 76/125 (60.8) | 0.038 |
| Piperacillin/tazobactam | 23/31 (74.2) | 116/125 (92.8) | 0.003 |
| Imipenem | 31/31 (100.0) | 125/125 (100.0) | 1.00 |
| Trimethoprim-sulfamethoxazole | 27/31 (87.1) | 74/125 (59.2) | 0.003 |
| Amikacin | 30/31 (96.8) | 124/125 (99.2) | 0.36 |
| Gentamicin | 27/31 (87.1) | 84/125 (67.2) | 0.03 |
| Tobramycin | 27/31 (87.1) | 81/125 (64.8) | 0.02 |
Values are n (%) unless otherwise indicated
aNot all of the isolates underwent susceptibility testing
bMeans cefotaxime or ceftriaxone. The susceptibility to third-generation cephalosporins was defined by the breakpoints of the 2008 Clinical Laboratory Standards Institute guidelines (susceptible, ≤ 8 μg/ml; intermediate, 16–32 μg/ml; and resistant, ≥ 64 μg/ml) [18]
Treatments and outcomes in patients with spontaneous bacterial peritonitis caused by Enterobacter species and Escherichia coli
| Variable |
|
|
|
|---|---|---|---|
| Initial empirical antimicrobial agent | |||
| Cefotaxime | 27 (84.4) | 116 (90.6) | 0.31 |
| Imipenem or meropenem | 4 (12.4) | 9 (7.0) | |
| Cefazolin | 1 (3.1) | 0 (0) | |
| Ceftazidime | 0 (0) | 1 (0.8) | |
| Cefepime | 0 (0) | 1 (0.8) | |
| Levofloxacin | 0 (0) | 1 (0.8) | |
| Appropriateness of initial therapy | 27 (87.1) | 109 (87.2) | 1.00 |
| Initial response to empirical treatmenta | 26/32 (81.3) | 95/117 (81.2) | 0.995 |
| Emergence of resistance during third-generation cephalosporin treatment | 1/23 (4.3) | 0/98 (0) | 0.19 |
| Duration of hospitalization, median days (IQR) | |||
| Overall | 20 (11–31) | 16 (10–26) | 0.28 |
| Survivors | 22 (12–31) | 16 (11–26) | 0.41 |
| Duration of antimicrobial use, median days (IQR) | |||
| Overall | 15 (11–25) | 13 (8–16) | 0.02 |
| Survivors | 16 (13–29) | 13 (10–16) | 0.01 |
| ICU care during admission | 2 (6.2) | 19 (14.8) | 0.25 |
| Mortality | |||
| 14-day mortality | 7 (21.9) | 25 (19.5) | 0.77 |
| 30-day mortality | 12 (37.5) | 37 (28.9) | 0.35 |
| In-hospital mortality | 12 (37.5) | 28 (21.9) | 0.07 |
Values are n (%) unless otherwise indicated. IQR interquartile range, ICU intensive care unit
aAscitic neutrophil decrease >25 % observed 48–72 h after initiating antimicrobials