Association of Proton Pump Inhibitor Therapy With Spontaneous Bacterial Peritonitis in Cirrhotic Patients With Ascites

Bajaj, Jasmohan S.; Zadvornova, Yelena; Heuman, Douglas M.; Hafeezullah, Muhammad; Hoffmann, Raymond G.; Sanyal, Arun J.; Saeian, Kia

doi:10.1038/ajg.2009.80

Cited by 194 publications

(216 citation statements)

References 25 publications

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“…Among 1141 cirrhotics 446 (39.05%) patients were on proton pump inhibitors where 228 out of 446 on PPI (51.12%) had infections with calculated odd ratio = 2.57 (95% CI 1.99 -3.319) and p value of 0.000. Bajaj JS et al [52] in their study showed that the use of PPI was independently associated with SBP (odds ratio 4.31, confidence interval 1.34 -11.7), and protein within ascitic fluid was found to be protective (OR 0.1, CI 0.03 -0.25). The above study also revealed that 47% of cirrhotic patients receiving PPI had no documented indication for PPI treatment.…”

Section: Discussionmentioning

confidence: 99%

Infections in Cirrhotics: Types, Microbiological Spectrum and Risk Factors—5-Year Cohort Study

Naqvi¹,

Mahmood²,

Talib³

et al. 2014

OJGas

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Cirrhosis is an immunocompromised state that leads to various infections, with an estimated 30% mortality. Pakistan already has a high morbidity and mortality related to complications of cirrhosis. Where the data on infection among cirrhotics is scanty, this study aimed to determine the frequency, microbiological spectrum and various risk factors of infections in cirrhosis of liver. This is a prospective cohort study conducted at a tertiary care hospital. The microbiological spectrum and frequency of infections was determined in cirrhotics.

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Section: Discussionmentioning

confidence: 99%

Infections in Cirrhotics: Types, Microbiological Spectrum and Risk Factors—5-Year Cohort Study

Naqvi¹,

Mahmood²,

Talib³

et al. 2014

OJGas

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“…A májelégtelenséget jelző paraméterek (bilirubin>55 µmol/L, thrombocytaszám<98 G/l) az SBP független rizikófaktorainak bizonyultak [31]. Retrospektív esetkontroll-vizsgálatok a protonpumpagátló (PPI-) kezelést hozták összefüggésbe az SBP kialakulásával [34,35]. Az erős savszekréció-gát-lás a gyomorsav antibakteriális hatásának kikapcsolásával a szájon át bekerülő baktériumok túlélését, így a vékony-bélbe jutását segítik, amely miatt nagyobb valószínűség-gel alakul ki SIBO.…”

Section: Az Sbp Hajlamosító Tényezőiunclassified

Spontán bakteriális peritonitis

Velkey

Vitális

2017

Orvosi Hetilap

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A spontán bakteriális peritonitis megjelenésére ascitessel járó májzsugorban szenvedőknél számíthatunk. A kóroko-zók intestinalis bakteriális transzlokáció útján a véráramba jutnak, majd az ascitesbe kerülve elszaporodnak. A betegség diagnózisa az ascites megemelkedett neutrofilszámának igazolásán alapszik (>0,25 G/L). A tenyésztés gyakran álnegatív, az antibiotikum-érzékenység meghatározása miatt mégis fontos. Kezelésére stabil betegekben iv., majd orálisan alkalmazott ciprofloxacint vagy amoxicillin/klavulánsavat ajánlanak, súlyosabb állapotban III. generációs cefalosporint. Nosocomialis infekció esetén a gyakoribb Gram-pozitív és antibiotikum-rezisztens patogének okozta fertőzés miatt imipenemet vagy meropenemet célszerű választani. Profilaxisként norfloxacint javasolnak, bár a fokozódó rezisztenciával számolni kell. Gastrointestinalis vérzés esetén öt napon át alkalmazott norfloxacin, súlyos máj-elégtelenek vérzése esetén ceftriaxon adása indokolt. Tartós antibiotikum-profilaxist (napi 400 mg norfloxacin) -primer prevencióként -alacsony ascitesösszfehérje-szintű, előrehaladott májzsugorosok számára ajánlanak, míg szekunder prevenció gyanánt minden spontán bakteriális peritonitisből felépült beteg számára indokolt adni. Nem mindenki ért egyet a tartós antibiotikum-profilaxissal. A cikk megírásának ösztönzője volt az a mindennapi tapasztalat, hogy a kórképpel kapcsolatos ismeretek nem eléggé állnak a cirrhosis kezelésének középpontjában. Orv. Hetil., 2017, 158(2), 50-57. Kulcsszavak: májzsugor, intestinalis bakteriális transzlokáció, kezelés, profilaxis Spontaneous bacterial peritonitisSpontaneous bacterial peritonitis occurs most commonly in cirrhotic patients with ascites. Pathogens get into the circulation by intestinal translocation and colonize in peritoneal fluid. Diagnosis of spontaneous bacterial peritonitis is based on elevated polymorphonuclear leukocyte count in the ascites (>0,25 G/L). Ascites culture is often negative but aids to get information about antibiotic sensitivity in positive cases. Treatment in stable patient can be intravenous then orally administrated ciprofloxacin or amoxicillin/clavulanic acid, while in severe cases intravenous III. generation cephalosporin. Nosocomial spontaneous bacterial peritonitis often caused by Gram-positive bacteria and multi-resistant pathogens can also be expected thus carbapenem should be the choice of the empiric treatment. Antibiotic prophylaxis should be considered. Norfloxacin is used most commonly, but changes are expected due to increase in quinolone resistance. As a primary prophylaxis, a short-term antibiotic treatment is recommended after gastrointestinal bleeding for 5 days, while long-term prophylaxis is for patients with low ascites protein, and advanced disease (400 mg/day). Secondary prophylaxis is recommended for all patients recovered from spontaneous bacterial peritonitis. Due to increasing antibiotic use of antibiotics prophylaxis is debated to some degree.

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“…We also attempt to perform swabs seeking for carriage of ESBL-producing strains in patients who are in frequent contact with the health care system and who fulfill the following criteria: on the waiting list, any admission for an acute decompensation of cirrhosis, refractory ascites treated by repeated largevolume paracentesis, use of long-term antibiotic prophylaxis. Since there are ten studies [22][23][24][25][26][27][28][29][30][31] and one metaanalysis [32] showing that the use of proton-pump inhibitors increases the risk of developing SBP, PPI administration should not be recommended, at least in patients with ascites.…”

mentioning

confidence: 99%

The burden of extended-spectrum β-lactamase-producing Enterobacteriaceae in patients with cirrhosis

Moreau

2014

Hepatol Int

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Association of Proton Pump Inhibitor Therapy With Spontaneous Bacterial Peritonitis in Cirrhotic Patients With Ascites

Abstract: PPI therapy is associated with SBP in patients with advanced cirrhosis. Prospective studies are needed to determine whether PPI avoidance can reduce the incidence of SBP and improve outcomes.

Cited by 194 publications

References 25 publications

Infections in Cirrhotics: Types, Microbiological Spectrum and Risk Factors—5-Year Cohort Study

Infections in Cirrhotics: Types, Microbiological Spectrum and Risk Factors—5-Year Cohort Study

Spontán bakteriális peritonitis

The burden of extended-spectrum β-lactamase-producing Enterobacteriaceae in patients with cirrhosis

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