#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Spontaneous bacterial peritonitis


Authors: Renáta Šenkeříková;  Soňa Fraňková;  Jan Šperl;  Julius Špičák
Authors‘ workplace: Souhrn ;  Klinika hepatogastroenterologie IKEM Praha, přednosta prof. MUDr. Julius Špičák, CSc.
Published in: Vnitř Lék 2015; 61(2): 134-140
Category: Review

Overview

Spontaneous bacterial peritonitis (SBP) represents a frequent and serious complication in patients with ascites in liver cirrhosis. Hospital mortality in patients with SBP reaches 10–20 %, so it is necessary to consider this diagnosis in every clinical decompensation of a cirrhotic patient, diagnose it early and treat it effectively. The clinical manifestation is nonspecific and variable, up to one third of patients might be asymptomatic. The diagnosis of SBP is based on the ascitic neutrophils count greater than 250 per mm3. Bacteriological examination of ascites fluid detects causative agents at less than half of the cases and the result is available after a few days. However, treatment should be initiated without delay. SBP is generally treated with antibiotics, the first choice therapy are the third generation cephalosporins, mostly cefotaxime, alternatively fluoroquinolones. Long-term prognosis of patients with the history of SBP is poor owing to its high recurrence rate, one-year survival after an episode of SBP is 30–40 %, 20 % at two years. Therefore, these patients should receive long-term antibiotic prophylaxis and should be evaluated for liver transplantation.

Key words:
diagnosis – liver cirrhosis – spontaneous bacterial peritonitis – therapy


Sources

1. Conn HO. Spontaneous Peritonitis and Bacteremia in Laennec’s Cirrhosis Caused by Enteric Organisms. A Relatively Common but Rarely Recognized Syndrome. Ann Intern Med 1964; 60: 568–580.

2. Wong F, Bernardi M, Balk R et al. Sepsis in cirrhosis: report on the 7th meeting of the International Ascites Club. Gut 2005; 54(5): 718–725.

3. European Association for the Study of the L. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol 2010; 53(3): 397–417.

4. Lata J, Fejfar T, Krechler T et al. Spontaneous bacterial peritonitis in the Czech Republic: prevalence and aetiology. Eur J Gastroenterol Hepatol 2003; 15(7): 739–743.

5. Evans LT, Kim WR, Poterucha JJ et al. Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites. Hepatology 2003; 37(4): 897–901.

6. Tandon P, Garcia-Tsao G. Bacterial infections, sepsis, and multiorgan failure in cirrhosis. Semin Liver Dis 2008; 28(1): 26–42.

7. Garcia-Tsao G. Current management of the complications of cirrhosis and portal hypertension: variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Gastroenterology 2001; 120(3): 726–748.

8. Runyon BA, AASLD. Introduction to the revised American Association for the Study of Liver Diseases. Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology 2013; 57(4): 1651–1653.

9. Runyon BA, Hoefs JC. Culture-negative neutrocytic ascites: a variant of spontaneous bacterial peritonitis. Hepatology 1984; 4(6): 1209–1211.

10. Rimola A, Garcia-Tsao G, Navasa M et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club. J Hepatol 2000; 32(1): 142–153.

11. Fernandez J, Navasa M, Gomez J et al. Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology 2002; 35(1): 140–148.

12. Perez-Paramo M, Munoz J, Albillos A et al. Effect of propranolol on the factors promoting bacterial translocation in cirrhotic rats with ascites. Hepatology 2000; 31(1): 43–48.

13. Lata J, Stiburek O, Kopacova M. Spontaneous bacterial peritonitis: a severe complication of liver cirrhosis. World J Gastroenterol 2009; 15(44): 5505–5510.

14. Guarner C, Runyon BA, Young S et al. Intestinal bacterial overgrowth and bacterial translocation in cirrhotic rats with ascites. J Hepatol 1997; 26(6): 1372–1378.

15. Cirera I, Bauer TM, Navasa M et al. Bacterial translocation of enteric organisms in patients with cirrhosis. J Hepatol 2001; 34(1): 32–37.

16. Ersoz G, Aydin A, Erdem S et al. Intestinal permeability in liver cirrhosis. Eur J Gastroenterol Hepatol 1999; 11(4): 409–412.

17. Runyon BA. Patients with deficient ascitic fluid opsonic activity are predisposed to spontaneous bacterial peritonitis. Hepatology 1988; 8(3): 632–635. Erratum in Hepatology 1988; 8(5): 1184.

18. Tritto G, Bechlis Z, Stadlbauer V et al. Evidence of neutrophil functional defect despite inflammation in stable cirrhosis. J Hepatol. 2011; 55(3): 574–581.

19. Ono Y, Watanabe T, Matsumoto K et al. Opsonophagocytic dysfunction in patients with liver cirrhosis and low responses to tumor necrosis factor-alpha and lipopolysaccharide in patients’ blood. J Infect Chemother 2004; 10(4): 200–207.

20. Stadlbauer V, Mookerjee RP, Hodges S et al. Effect of probiotic treatment on deranged neutrophil function and cytokine responses in patients with compensated alcoholic cirrhosis. J Hepatol 2008; 48(6): 945–951.

21. Senkerikova R, de Mare-Bredemeijer E, Frankova S et al. Genetic variation in TNFA predicts protection from severe bacterial infections in patients with end-stage liver disease awaiting liver transplantation. J Hepatol 2014; 60(4): 773–781.

22. Lata J, Novotny I, Pribramska V et al. The effect of probiotics on gut flora, level of endotoxin and Child-Pugh score in cirrhotic patients: results of a double-blind randomized study. Eur J Gastroenterol Hepatol 2007; 19(12): 1111–1113.

23. Nousbaum JB, Cadranel JF, Nahon P et al. Diagnostic accuracy of the Multistix 8 SG reagent strip in diagnosis of spontaneous bacterial peritonitis. Hepatology 2007; 45(5): 1275–1281.

24. Ortiz J, Soriano G, Coll P et al. Early microbiologic diagnosis of spontaneous bacterial peritonitis with BacT/ALERT. J Hepatol 1997; 26(4): 839–844.

25. Castellote J, Xiol X, Verdaguer R et al. Comparison of two ascitic fluid culture methods in cirrhotic patients with spontaneous bacterial peritonitis. Am J Gastroenterol 1990; 85(12): 1605–1608.

26. Guarner C, Soriano G. Spontaneous bacterial peritonitis. Semin Liver Dis 1997; 17(3): 203–217.

27. Runyon BA, McHutchison JG, Antillon MR et al. Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis. A randomized controlled study of 100 patients. Gastroenterology 1991; 100(6): 1737–1742.

28. Navasa M, Follo A, Llovet JM et al. Randomized, comparative study of oral ofloxacin versus intravenous cefotaxime in spontaneous bacterial peritonitis. Gastroenterology 1996; 111(4): 1011–1017.

29. Gomez-Jimenez J, Ribera E, Gasser I et al. Randomized trial comparing ceftriaxone with cefonicid for treatment of spontaneous bacterial peritonitis in cirrhotic patients. Antimicrob Agents Chemother 1993; 37(8): 1587–1592.

30. Ricart E, Soriano G, Novella MT et al. Amoxicillin-clavulanic acid versus cefotaxime in the therapy of bacterial infections in cirrhotic patients. J Hepatol 2000; 32(4): 596–602.

31. Terg R, Cobas S, Fassio E et al. Oral ciprofloxacin after a short course of intravenous ciprofloxacin in the treatment of spontaneous bacterial peritonitis: results of a multicenter, randomized study. J Hepatol 2000; 33(4): 564–569.

32. Song KH, Jeon JH, Park WB et al. Clinical outcomes of spontaneous bacterial peritonitis due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species: a retrospective matched case-control study. BMC Infect Dis 2009; 9: 41. Dostupné z DOI: <http://doi: 10.1186/1471–2334–9-41>.

33. Garcia-Tsao G. Bacterial infections in cirrhosis: treatment and prophylaxis. J Hepatol 2005; 42(Suppl 1): S85-S92.

34. Sort P, Navasa M, Arroyo V et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 1999; 341(6): 403–409.

35. Bajaj JS, Ananthakrishnan AN, Hafeezullah M et al. Clostridium difficile is associated with poor outcomes in patients with cirrhosis: A national and tertiary center perspective. Am J Gastroenterol 2010; 105(1): 106–113.

36. Novella M, Sola R, Soriano G et al. Continuous versus inpatient prophylaxis of the first episode of spontaneous bacterial peritonitis with norfloxacin. Hepatology 1997; 25(3): 532–536.

37. Alvarez RF, Mattos AA, Correa EB et al. Trimethoprim-sulfamethoxazole versus norfloxacin in the prophylaxis of spontaneous bacterial peritonitis in cirrhosis. Arq Gastroenterol 2005; 42(4): 256–262.

38. Bauer TM, Follo A, Navasa M et al. Daily norfloxacin is more effective than weekly rufloxacin in prevention of spontaneous bacterial peritonitis recurrence. Dig Dis Sci 2002; 47(6): 1356–1361.

39. Bleichner G, Boulanger R, Squara P et al. Frequency of infections in cirrhotic patients presenting with acute gastrointestinal haemorrhage. Br J Surg 1986; 73(9): 724–726.

40. Hou MC, Lin HC, Liu TT et al. Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: a randomized trial. Hepatology 2004; 39(3): 746–753.

41. Cohen MJ, Sahar T, Benenson S et al. Antibiotic prophylaxis for spontaneous bacterial peritonitis in cirrhotic patients with ascites, without gastro-intestinal bleeding. Cochrane Database Syst Rev 2009(2): CD004791. Dostupné z DOI: <http://doi: 10.1002/14651858.CD004791.pub2>.

42. Andreu M, Sola R, Sitges-Serra A et al. Risk factors for spontaneous bacterial peritonitis in cirrhotic patients with ascites. Gastroenterology 1993; 104(4): 1133–1138.

43. Fernandez J, Navasa M, Planas R et al. Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. Gastroenterology 2007; 133(3): 818–824.

44. Deshpande A, Pasupuleti V, Thota P et al. Acid-suppressive therapy is associated with spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis. J Gastroenterol Hepatol 2013; 28(2): 235–242.

45. Ratelle M, Perreault S, Villeneuve JP et al. Association between proton pump inhibitor use and spontaneous bacterial peritonitis in cirrhotic patients with ascites. Can J Gastroenterol Hepatol 2014; 28(6): 330–334.

46. Terg R, Casciato P, Garbe C et al. Proton Pump Inhibitor Therapy Does Not Increase the Incidence of Spontaneous Bacterial Peritonitis in Cirrhosis: A Multicenter Prospective Study. J Hepatol 2014; pii: S0168–8278(14)00885-X. Dostupné z DOI: <http://doi: 10.1016/j.jhep.2014.11.036>.

47. Mandorfer M, Bota S, Schwabl P et al. Proton pump inhibitor intake neither predisposes to spontaneous bacterial peritonitis or other infections nor increases mortality in patients with cirrhosis and ascites. PLoS One 2014; 9(11): e110503. Dostupné z DOI: <http://doi: 10.1371/journal.pone.0110503>.

48. Krag A, Wiest R, Albillos A et al. The window hypothesis: haemodynamic and non-haemodynamic effects of beta-blockers improve survival of patients with cirrhosis during a window in the disease. Gut 2012; 61(7): 967–969.

49. Lebrec D, Poynard T, Hillon P et al. Propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis: a controlled study. N Engl J Med 1981; 305(23): 1371–1374.

50. Pascal JP, Cales P. Propranolol in the prevention of first upper gastrointestinal tract hemorrhage in patients with cirrhosis of the liver and esophageal varices. N Engl J Med 1987; 317(14): 856–861.

51. Serste T, Melot C, Francoz C et al. Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites. Hepatology 2010; 52(3): 1017–1022.

52. Serste T, Francoz C, Durand F et al. Beta-blockers cause paracentesis-induced circulatory dysfunction in patients with cirrhosis and refractory ascites: a cross-over study. J Hepatol 2011; 55(4): 794–799.

53. Llach J, Gines P, Arroyo V et al. Prognostic value of arterial pressure, endogenous vasoactive systems, and renal function in cirrhotic patients admitted to the hospital for the treatment of ascites. Gastroenterology 1988; 94(2): 482–487.

54. Krag A, Bendtsen F, Henriksen JH et al. Low cardiac output predicts development of hepatorenal syndrome and survival in patients with cirrhosis and ascites. Gut 2010; 59(1): 105–110.

55. Mandorfer M, Bota S, Schwabl P et al. Nonselective β blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis Gastroenterology 2014; 146(7): 1680–1690.

56. Hoefs JC, Runyon BA. Spontaneous bacterial peritonitis. Dis Mon 1985; 31(9): 1–48.

57. Boyer T, Manns M, Sanyal A et al. Ascites. In: Arun J, Sanyal MD (eds). Zakim and Boyer’s Hepatology: A Textbook of Liver Disease – Expert Consult. 6th ed. Elsevier-Saunders: 2011. ISBN 978–1437708813.

Labels
Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 2

2015 Issue 2

Most read in this issue
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#