Oral Antibiotic Prophylaxis Reduces Spontaneous Bacterial Peritonitis Occurrence and Improves Short-Term Survival in Cirrhosis: A Meta-Analysis

Saab, Sammy; Hernandez, James R.; Amanda, C.; Tong, Myron J.

doi:10.1038/ajg.2009.3

Cited by 91 publications

(54 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, four trials also included patients with prior SBP132 139 142 143 and the remaining have recently been summarised in two meta-analyses 136 137. Surprisingly, these came to different conclusions, most likely due to erroneous data extraction 144.…”

Section: Prevention Of Sbpmentioning

confidence: 99%

Spontaneous bacterial peritonitis: recent guidelines and beyond

Wiest

Krag

Gerbes

2011

Gut

335

298

View full text Add to dashboard Cite

Section: Prevention Of Sbpmentioning

confidence: 99%

Spontaneous bacterial peritonitis: recent guidelines and beyond

Wiest

Krag

Gerbes

2011

Gut

335

298

View full text Add to dashboard Cite

“…Criteria for defining advanced liver disease included Child-Pugh scores > 9, bilirubin levels > 2.5 mg/dL, and impaired renal function. The analysis showed that prophylaxis improved short-term survival and reduced the incidence of infections, including SBP [73] . These results suggest that primary prophylaxis has a great impact in the clinical course of patients with low ascites protein content and advanced cirrhosis, and may reduce the incidence of SBP and improve survival.…”

Section: Primary Prophylaxis In Patients With Ascitesmentioning

confidence: 99%

Diagnosis and management of bacterial infections in decompensated cirrhosis

Pleguezuelo

Benítez²,

Jurado³

et al. 2013

WJH

View full text Add to dashboard Cite

Bacterial infections are one of the most frequent complications in cirrhosis and result in high mortality rates. Patients with cirrhosis have altered and impaired immunity, which favours bacterial translocation. Episodes of infections are more frequent in patients with decompensated cirrhosis than those with compensated liver disease. The most common and life-threatening infection in cirrhosis is spontaneous bacterial peritonitis followed by urinary tract infections, pneumonia, endocarditis and skin and soft-tissue infections. Patients with decompensated cirrhosis have increased risk of developing sepsis, multiple organ failure and death. Risk factors associated with the development of infections are severe liver failure, variceal bleeding, low ascitic protein level and prior episodes of spontaneous bacterial peritonitis (SBP). The prognosis of these patients is closely related to a prompt and accurate diagnosis. An appropriate treatment decreases the mortality rates. Preventive strategies are the mainstay of the management of these patients. Empirical antibiotics should be started immediately following the diagnosis of SBP and the first-line antibiotic treatment is third-generation cephalosporins. However, the efficacy of currently recommended empirical antibiotic therapy is very low in nosocomial infections including SBP, compared to community-acquired episodes. This may be associated with the emergence of infections caused by Enterococcus faecium and extended-spectrum β-lactamaseproducing Enterobacteriaceae, which are resistant to the first line antimicrobial agents used for treatment. The emergence of resistant bacteria, underlines the need to restrict the use of prophylactic antibiotics to patients with the greatest risk of infections. Nosocomial infections should be treated with wide spectrum antibiotics. Further studies of early diagnosis, prevention and treatment are needed to improve the outcomes in patients with decompensated cirrhosis.

show abstract

“…A bakteriális transzlokációból származó szóródás elméletét támogatta, hogy amennyiben egyéb úton (például portalis nyomást csökkentő kezelés révén) sikerül a BT mértékét csökkenteni, úgy az SBP incidenciája is csökken [22]. A bél antibiotikummal történt dekontaminációja szintén csökkenti az SBP kialakulásának valószínűségét [23]. Ezek alapján az SBP-t a BT tükrének tartották.…”

Section: áBraunclassified

Spontán bakteriális peritonitis

Velkey

Vitális

2017

Orvosi Hetilap

View full text Add to dashboard Cite

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.

show abstract

Oral Antibiotic Prophylaxis Reduces Spontaneous Bacterial Peritonitis Occurrence and Improves Short-Term Survival in Cirrhosis: A Meta-Analysis

Cited by 91 publications

References 23 publications

Spontaneous bacterial peritonitis: recent guidelines and beyond

Spontaneous bacterial peritonitis: recent guidelines and beyond

Diagnosis and management of bacterial infections in decompensated cirrhosis

Spontán bakteriális peritonitis

Contact Info

Product

Resources

About