Detection of ascitic fluid infections in patients with liver cirrhosis and ascites

Mostafa, Mohammed; El-Seidi, Eman Ahmed; Kassem, Abdel Meguid; Shemis, Mohamed; Saber, Mohamed; Michael, Michael N.

doi:10.1016/j.ajg.2011.01.004

Cited by 18 publications

(22 citation statements)

References 29 publications

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“…Our 16S PCR was able to detect bacterial DNA in 100% (17/17) of culture-positive samples, and HRMA was able to correctly identify the bacterial species identified by culture in 70.6% (12/17) of positive samples in our study. The rate of positivity for bacterial DNA, 19.8% (21/106), detected from ascitic fluid samples in our study is comparable with the rates in other reported studies (3,4,8,9,11,12,(19)(20)(21)29). The overall sensitivity for detecting the presence of eubacterial DNA in an ascitic fluid sample and the specificity for the 16S PCR were high, at 100% (17/17) and 91.5% (85/89), respectively.…”

Section: Discussionsupporting

confidence: 79%

“…pontaneous bacterial peritonitis (SBP) is a common and potentially fatal bacterial infection in patients with cirrhosis and ascites, occurring in 10 to 30% of patients, with in-hospital mortality rates ranging from 20 to 30% (1,2,(6)(7)(8)12). It is secondary to impaired humoral and cellular immune responses that result in indirect intestinal bacterial translocation into the ascitic fluid (1, 2, 6-8, 16, 20).…”

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confidence: 99%

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Identification of Bacterial Pathogens in Ascitic Fluids from Patients with Suspected Spontaneous Bacterial Peritonitis by Use of Broad-Range PCR (16S PCR) Coupled with High-Resolution Melt Analysis

et al. 2012

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bSpontaneous bacterial peritonitis (SBP) can be a severe complication occurring in patients with cirrhosis and ascites, with associated mortality often as high as 40%. Traditional diagnostics for SBP rely on culture techniques for proper diagnosis, although recent reports suggest that the presence of bacterial DNA in peritoneal fluid in patients with cirrhosis and ascites is an indicator of SBP. A previously published broad-range PCR (16S PCR) coupled with high-resolution melt analysis (HRMA) was compared with standard culture techniques for diagnosis of SBP in 106 peritoneal fluid samples from patients with suspected SBP. The sensitivity and specificity for 16S PCR for detecting eubacterial DNA compared with those of standard culture techniques were 100% (17/17) and 91.5% (85/89), respectively. Overall, HRMA concordance with species identification was 70.6% (12/17), although the 5 samples that were discordant at the species level were SBP resulting from a polymicrobial infection, and specieslevel identification for polymicrobial infections is outside the capability of HRMA. Both the broad-range 16S PCR and HRMA analysis provide useful diagnostic adjunctive assays for clinicians in detecting and identifying pathogens responsible for SBP. Spontaneous bacterial peritonitis (SBP) is a common and potentially fatal bacterial infection in patients with cirrhosis and ascites, occurring in 10 to 30% of patients, with in-hospital mortality rates ranging from 20 to 30% (1, 2, 6-8, 12). It is secondary to impaired humoral and cellular immune responses that result in indirect intestinal bacterial translocation into the ascitic fluid (1, 2, 6-8, 16, 20). SBP is also associated with a poor long-term prognosis for patients, as mortality rates can reach 50 to 70% at 1 year (2). Given that timely and appropriate antibiotic treatment can improve the clinical outcome, rapid and accurate diagnostic methods for early detection of eubacterial infection responsible for SBP and identification of the causative organisms involved could be particularly useful in acute care settings. Recent attention drawn to the changing microbial and resistance patterns attributed to the increasing use of antibiotic prophylaxis and invasive procedures in such patients further underscores the importance of identifying the causative pathogen to ensure adequate antibiotic coverage (13).Current laboratory diagnosis of SBP is defined as Ն250 polymorphonuclear (PMN) cells/ml and a positive culture from ascitic fluid from the patient (1-13, 15-17, 19-22, 29). Unfortunately, the prolonged turnaround time (1 to 2 days) of culture limits its utility for directing antibiotic selection in acute care settings. Ascitic fluid culture has also been reported to be negative in approximately 20% of patients with clinical manifestations suggestive of SBP and an ascitic PMN count of Ͼ250, so-called culture-negative neutrocytic ascites. On the other hand, a low ascitic PMN count (Ͻ250) with positive culture can also occur in another SBP variant called bacterascites, or monom...

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Section: Discussionsupporting

confidence: 79%

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confidence: 99%

Identification of Bacterial Pathogens in Ascitic Fluids from Patients with Suspected Spontaneous Bacterial Peritonitis by Use of Broad-Range PCR (16S PCR) Coupled with High-Resolution Melt Analysis

et al. 2012

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“…[13][14][15][16] Although the mean age among the individuals with SBP was somewhat lower than previously described by other authors (52.8 to 58.4 years), [13][14][15][16] in line with what was found in the present study. 14,16,19 With regard to the etiology of cirrhosis, Heo et al reported…”

Section: Discussionsupporting

confidence: 61%

Clinical and laboratorial features of spontaneous bacterial peritonitis in southern Brazil

et al. 2014

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CONTEXT AND OBJECTIVE: Spontaneous bacterial peritonitis (SBP) is a severe complication that occurs in 8-27% of hospitalized patients with liver cirrhosis and ascites, with high mortality rates. This study aimed to identify the clinical characteristics associated with SBP. DESIGN AND SETTING: Cross-sectional study, conducted in a public university. The subjects were divided into two groups: SBP and controls. RESULTS:Comparison between individuals with SBP and controls showed that those with SBP had lower mean prothrombin activity time (36.1 ± 16.0% versus 47.1 ± 17.2%; P = 0.044) and lower median serum-ascites albumin gradient (SAAG) (1.2 versus 1.7, P = 0.045). There was a tendency towards higher mean MELD in the SBP group, not significant (22.2 ± 7.6 versus 17.9 ± 6.7; P = 0.067). There was a strong positive correlation between the neutrophil count in ascitic fluid and serum leukocyte count (r = 0.501; P = 0.001) and a negative correlation between the neutrophil count in ascitic fluid with prothrombin activity time (r = -0.385; P = 0.011).CONCLUSION: A few characteristics are associated with the presence of SBP, especially liver dysfunction, SAAG and peripheral leukocytosis. RESULTADOS: Quando se compararam os indivíduos com PBE aos controles, observou-se menor média de tempo de atividade da protrombina (TAP; 36,1 ± 16,0% versus 47,1 ± 17,2%; P = 0,044) e menor mediana de gradiente albumina soro-ascite (GASA; 1,2 versus 1,7; P = 0,045). Houve tendência do grupo com PBE de apresentar maior média de MELD, sem significância estatística (22,2 ± 7,6 versus 17,9 ± 6,7; P = 0,067). Foi observada forte correlação positiva entre neutrófilos do líquido ascítico e contagem sérica de leucócitos (r = 0,501; P = 0,001) e correlação negativa de neutrófilos do líquido ascítico com TAP (r = -0,385; P = 0,011). CONCLUSÃO: Poucas características estão associadas à presença de PBE, em especial a disfunção hepáti-ca, o GASA e a leucocitose periférica. RESUMO

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“…Classified as spontaneous bacterial peritonitis (SBP) with polymorphnuclear (PMN) count >250 mm 3 and positive ascitic fluid culture without any evidence of external or intraabdominal source of infection 2 or malignancy 3, culture-negative SBP with PMN >250 mm 3 and a negative ascitic fluid culture 4, bacterascites with a positive ascitic fluid culture and an ascitic PMN count <250 cells/mm 3 5 and steril ascites with PMN <250 mm 3 and a negative ascitic fluid culture 6, ascitic fluid infections are considered serious complications in cirrhotic patients with a reported incidence of 8-30% 2 and high morbidity and mortality 7.…”

Section: Introductionmentioning

confidence: 99%

The Role of Serum Procalcitonin Levels in Predicting Ascitic Fluid Infection in Hospitalized Cirrhotic and Non-cirrhotic Patients

Çekın¹,

Çekın²,

Duman³

et al. 2013

Int. J. Med. Sci.

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Objective: To determine the role of serum procalcitonin levels in predicting ascites infection in hospitalized cirrhotic and non-cirrhotic patients.Methods: A total of 101 patients (mean age: 63.4±1.3, 66.3% were males) hospitalized due to cirrhosis (n=88) or malignancy related (n=13) ascites were included in this study. Spontaneous bacterial peritonitis (SBP, 19.8%), culture-negative SBP (38.6%), bacterascites (4.9%), sterile ascites (23.8%) and malign ascites (12.9%) groups were compared in terms of procalcitonin levels in predicting ascites infection. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of procalcitonin levels and predicting outcome of procalcitonin levels was compared with C-reactive protein (CRP).Results: Culture positivity was determined in 26.7% of overall population. Serum procalcitonin levels were determined to be significantly higher in patients with positive bacterial culture in ascitic fluid compared to patients without culture positivity (median (min-max): 4.1 (0.2-36.4) vs. 0.4 (0.04-15.8), p<0.001). Using ROC analysis, a serum procalcitonin level of <0.61 ng/mL in SBP (area under curve (AUC): 0.981, CI 95%: 0.000-1.000, p<0.001), <0.225 ng/mL in culture-negative SBP (AUC: 0.743, CI 95%: 0.619-0.867, p<0.001), <0.42 ng/mL in SBP and culture-negative SBP patients (AUC: 0.824, CI 95%: 0.732-0.916, p<0.001), and <1.12 ng/mL in bacterascites (AUC: 0.837, CI 95%: 0.000-1.000, p=0.019) were determined to accurately rule out the diagnosis of bacterial peritonitis. Predictive power of serum procalcitonin levels in SBP + culture-negative SBP group (AUCs: 0.824 vs 0.622, p=0.004, Fig 4), culture-positive SBP (AUCs: 0.981 vs 0.777, p=0.006, Fig 5) and (although less powerfull) in culture-negative SBP (AUCs: 0.743 vs 0.543, p=0.02, Fig 6) were found significantly higher than CRP.Conclusion: According to our findings determination of serum procalcitonin levels seems to provide satisfactory diagnostic accuracy in differentiating bacterial infections in hospitalized patients with liver cirrhosis related ascites.

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Detection of ascitic fluid infections in patients with liver cirrhosis and ascites

Cited by 18 publications

References 29 publications

Identification of Bacterial Pathogens in Ascitic Fluids from Patients with Suspected Spontaneous Bacterial Peritonitis by Use of Broad-Range PCR (16S PCR) Coupled with High-Resolution Melt Analysis

Identification of Bacterial Pathogens in Ascitic Fluids from Patients with Suspected Spontaneous Bacterial Peritonitis by Use of Broad-Range PCR (16S PCR) Coupled with High-Resolution Melt Analysis

Clinical and laboratorial features of spontaneous bacterial peritonitis in southern Brazil

The Role of Serum Procalcitonin Levels in Predicting Ascitic Fluid Infection in Hospitalized Cirrhotic and Non-cirrhotic Patients

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