INTRODUCTION: Burkholderia cepacia complex (Bcc) is non-fermenting Gram-negative bacillus and has been rarely reported to cause spontaneous bacterial peritonitis (SBP) in decompensated cirrhosis. OBJECTIVE: This study was done to evaluate the clinical presentation of cirrhotic patients with SBP due to Bcc and to determine its impact on clinical outcome. METHODS: This is a retrospective, observational study conducted during the period from 1st January 2013 through 31st March 2015. Medical records and microbiology laboratory files were reviewed to identify all cases of Bcc associated SBP among patients hospitalized at the liver intensive care unit and analyzed. RESULTS: During the study period, out of 252 SBP patients, 11 (4.3%) patients with a positive ascitic fluid culture for Bcc were identified. Pain abdomen was the predominant symptom present in 9 (81%) patients followed by hepatic encephalopathy in 7 (63%) patients. Acute kidney injury (AKI) was universally present, seen in 6 (54%) patients at the time of presentation and 4 (36%) patients developed AKI during hospital stay. The mean CTP score was 11.2 ± 1.1 (10-13), and the mean MELD was 24.3 ± 5.9 (14-35). The mean SOFA and APACHE II score at presentation were 11 ± 4.2 (4-18) and 19.4 ± 5.2 (11-28), respectively. A total of 8 (72%) patients (6-ACLF, 2-NASH) succumbed to the illness during hospitalization due to severe sepsis and multiorgan dysfunction and 3 (27%) patients are doing well on follow-up after 3 months. CONCLUSION: SBP caused by Bcc has been rarely reported in cirrhotic patients. This organism is intrinsically resistant to third generation cephalosporins, which are the initial antibiotic of choice for SBP patients, hence associated with multi organ failure and high mortality rates.
INTRODUCTION:Burkholderia cepacia complex (Bcc) is non-fermenting Gram-negative bacillus and has been rarely reported to cause spontaneous bacterial peritonitis (SBP) in decompensated cirrhosis. OBJECTIVE: This study was done to evaluate the clinical presentation of cirrhotic patients with SBP due to Bcc and to determine its impact on clinical outcome. METHODS: This is a retrospective, observational study conducted during the period from 1st January 2013 through 31st March 2015. Medical records and microbiology laboratory files were reviewed to identify all cases of Bcc associated SBP among patients hospitalized at the liver intensive care unit and analyzed. RESULTS: During the study period, out of 252 SBP patients, 11 (4.3%) patients with a positive ascitic fluid culture for Bcc were identified. Pain abdomen was the predominant symptom present in 9 (81%) patients followed by hepatic encephalopathy in 7 (63%) patients. Acute kidney injury (AKI) was universally present, seen in 6 (54%) patients at the time of presentation and 4 (36%) patients developed AKI during hospital stay. The mean CTP score was 11.2 ± 1.1 (10-13), and the mean MELD was 24.3 ± 5.9 (14-35). The mean SOFA and APACHE II score at presentation were 11 ± 4.2 (4-18) and 19.4 ± 5.2 (11-28), respectively. A total of 8 (72%) patients (6-ACLF, 2-NASH) succumbed to the illness during hospitalization due to severe sepsis and multiorgan dysfunction and 3 (27%) patients are doing well on follow-up after 3 months. CONCLUSION: SBP caused by Bcc has been rarely reported in cirrhotic patients. This organism is intrinsically resistant to third generation cephalosporins, which are the initial antibiotic of choice for SBP patients, hence associated with multi organ failure and high mortality rates.
Entities:
Keywords:
AKI, acute kidney injury; APACHE II, Acute Physiology and Chronic Health Evaluation (APACHE); APASL, Asia Pacific Association for the Study of Liver; Bcc, Burkholderia cepacia complex; CSLI, The Clinical and Laboratory Standards Institute; CTP, Child Turcotte Pugh Score; HCV, Hepatitis C virus; ICU, intensive care unit; NASH, non-alcoholic steatohepatitis; PGIMER, Postgraduate Institute of Medical Education and Research; SBP, spontaneous bacterial infection; SIRS, systemic inflammatory response syndrome; SOFA, The Sequential Organ Failure Assessment; UTI, urinary tract infection; cirrhosis; infection; spontaneous bacterial peritonitis
Authors: Vikas Gautam; Anita Arora; S K Madhup; Anindita Das; P Vandamme; Kusum Sharma; Vipin Koushal; Deepak Bansal; Meera Sharma; R K Garg; Sudesh Rana; R K Marwaha; Pallab Ray Journal: Indian J Med Res Date: 2010-06 Impact factor: 2.375
Authors: P Sort; M Navasa; V Arroyo; X Aldeguer; R Planas; L Ruiz-del-Arbol; L Castells; V Vargas; G Soriano; M Guevara; P Ginès; J Rodés Journal: N Engl J Med Date: 1999-08-05 Impact factor: 91.245