Prognosis and long-term recurrence of spontaneous bacterial peritonitis in cirrhosis

Silvain, Christine; Besson, Isabelle; Ingrand, Pierre; Mannant, P.-R.; Fort, Eric; Beauchant, Michel

doi:10.1016/s0168-8278(05)80196-5

Cited by 34 publications

(19 citation statements)

References 2 publications

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“…It has been proposed to be related to previous administration of norfloxacin prophylaxis or other interventions. Further, in these patients, co-existent type I hepatorenal syndrome is infrequent, recurrence of peritoneal fluid infection is unusual even in the absence of antibiotic prophylaxis, and 1 year mortality rate is low (33% vs. 50% to 70%) [8,17,18]. In our study, E. coli, Klebsiella spp.…”

Section: Discussionmentioning

confidence: 44%

Prevalence and risk factors for unsuspected spontaneous ascitic fluid infection in cirrhotics undergoing therapeutic paracentesis in an outpatient clinic

Mohan

Venkataraman

2011

Indian J Gastroenterol

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Section: Discussionmentioning

confidence: 44%

Prevalence and risk factors for unsuspected spontaneous ascitic fluid infection in cirrhotics undergoing therapeutic paracentesis in an outpatient clinic

Mohan

Venkataraman

2011

Indian J Gastroenterol

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“…Moreover, only one third of the outpatients diagnosed with SBP died within 1 year of the outpatient paracentesis as compared with a 1-year mortality of 50% to 70% in historically hospitalized patients with SBP. 1 It does appear, however, that SBP in asymptomatic outpatients has distinguishing features from SBP in hospitalized patients and may be a separate entity. The organisms cultured are predominantly gram positive in outpatients as compared with gram negative in hospitalized patients.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Bacterial Peritonitis in Asymptomatic Outpatients With Cirrhotic Ascites

2003

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The prevalence and natural history of spontaneous bacterial peritonitis in asymptomatic patients with ascites secondary to cirrhosis is unknown. From a prospectively recorded database, we reviewed the clinical and laboratory features of all outpatients with cirrhotic ascites undergoing paracentesis between July 1994 and December 2000. The prevalence of spontaneous bacterial peritonitis in the population of 427 cirrhotic outpatients as defined by neutrocytic ascites (absolute neutrophil count >250 cells/mm 3 ) was 3.5%. Of the 15 patients with neutrocytic ascites, 6 were culture positive (1.4%) and 9 culture negative (2.1%). Eight other patients (1.9%) had bacterascites. The organisms cultured from ascitic fluid in these asymptomatic patients with culture positive neutrocytic ascites and bacterascites were predominantly gram positive. No patient developed hepatorenal syndrome, and 1-year survival of 67% was better than historical data from hospitalized patients with spontaneous bacterial peritonitis. Moreover, patients who did not receive antibiotics for neutrocytic ascites fared no worse than patients who did receive antibiotics. In conclusion, spontaneous bacterial peritonitis in outpatients with cirrhotic ascites is less frequent, occurs in patients with less advanced liver disease, and may have a better outcome than its counterpart in hospitalized patients. S pontaneous bacterial peritonitis (SBP) is a potentially life-threatening complication in patients with cirrhosis and has typically been described in hospitalized patients. In this group, SBP may be complicated by renal failure, systemic sepsis, recurrence, and diminished survival. 1-3 The prevalence of SBP in hospitalized patients with cirrhosis and ascites is between 10% and 30%. [4][5][6] The prevalence and outcome of SBP in asymptomatic outpatients with cirrhotic ascites has been less well studied. A small study of 29 patients with ascites undergoing repeated large volume paracentesis for refractory ascites did not demonstrate any patients with SBP. 7 In 1998, the American Association for the Study of Liver Disease (AASLD) published guidelines for the initial ascitic fluid analysis in outpatients with cirrhosis. 8 The guidelines recommend determination of total nucleated cell count and a differential cell count on the initial ascitic fluid sample. Routine ascitic fluid bacterial cultures are not recommended unless infection is suspected. The AASLD guidelines recommend that a second paracentesis be carried out to obtain ascitic fluid for bacterial culture and antibiotic susceptibilities if the initial paracentesis shows an absolute neutrophil count of Ն250 cells/mm 3 (neutrocytic ascites). This recommendation, however, is based on data from a small Spanish study of 51 patients published only in abstract form. 9 The International Ascites Club recommends that routine cultures be obtained on ascitic fluid in hospitalized patients; the issue of ascitic fluid cultures in outpatients undergoing paracentesis is not addressed. 10 Thus, it appears that the majo...

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“…Until now, prophylaxis of SBP with quinolones has been strongly recommended for patients with previous SBP because they are at high risk of SBP recurrence (32-70%) at one year [6][7][8][9]. In addition, primary prophylaxis had also been recommended to patients with cirrhosis and gastrointestinal bleeding.…”

Section: Introductionmentioning

confidence: 99%

Ciprofloxacin in primary prophylaxis of spontaneous bacterial peritonitis: A randomized, placebo-controlled study

Terg¹,

Fassio

Guevara

et al. 2008

Journal of Hepatology

138

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Prognosis and long-term recurrence of spontaneous bacterial peritonitis in cirrhosis

Cited by 34 publications

References 2 publications

Prevalence and risk factors for unsuspected spontaneous ascitic fluid infection in cirrhotics undergoing therapeutic paracentesis in an outpatient clinic

Prevalence and risk factors for unsuspected spontaneous ascitic fluid infection in cirrhotics undergoing therapeutic paracentesis in an outpatient clinic

Spontaneous Bacterial Peritonitis in Asymptomatic Outpatients With Cirrhotic Ascites

Ciprofloxacin in primary prophylaxis of spontaneous bacterial peritonitis: A randomized, placebo-controlled study

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