본문 바로가기
KERD
논문KCI 등재

Clinical Features and Prognosis of Spontaneous Bacterial Peritonitis in Korean Patients with Liver Cirrhosis: A Multicenter Retrospective Study

2

조회

0

다운로드

6

인용

0

참고문헌

키워드

초록

Background/Aims: Although early recognition and treatment with effective antibiotics have lead to improvements in the prognosis of patients with spontaneous bacterial peritonitis (SBP), it remains to be a serious complication in cirrhotic patients. This study was designed to evaluate the clinical manifestations and prognosis of patients with liver cirrhosis and SBP in Korea. Methods: This was a multicenter retrospective study examining 157 episodes of SBP in 145 patients with cirrhosis. SBP was diagnosed based on a polymorphonuclear cell count in ascitic fluid of > 250 cells/mm3 in the absence of data compatible with secondary peritonitis. Results: The mean age of the cohort was 56 years, and 121 (77%) of the 157 episodes of SBP occurred in men. Microorganisms were isolated in 66 episodes (42%): Gram-negative bacteria in 54 (81.8%), Gram-positive in 11 (16.7%), and Candida in 1. Isolated Gram-negative organisms were resistant to third-generation cephalosporin in 6 cases (17%), to ciprofloxacin in 11 (20.8%), and to penicillin in 33 (62.3%). The treatment failure and in-hospital mortality rates were 12.1% and 21%, respectively. A high Model of End-Stage Liver Disease (MELD) score, SBP caused by extended-spectrum β-lactamase-producing organisms, and hepatocellular carcinoma were independent prognostic factors of high in-hospital mortality. Conclusions: SBP remains to be a serious complication with high in-hospital mortality, especially in patients with a high MELD score.

Abstract

Background/Aims: Although early recognition and treatment with effective antibiotics have lead to improvements in the prognosis of patients with spontaneous bacterial peritonitis (SBP), it remains to be a serious complication in cirrhotic patients. This study was designed to evaluate the clinical manifestations and prognosis of patients with liver cirrhosis and SBP in Korea. Methods: This was a multicenter retrospective study examining 157 episodes of SBP in 145 patients with cirrhosis. SBP was diagnosed based on a polymorphonuclear cell count in ascitic fluid of > 250 cells/mm3 in the absence of data compatible with secondary peritonitis. Results: The mean age of the cohort was 56 years, and 121 (77%) of the 157 episodes of SBP occurred in men. Microorganisms were isolated in 66 episodes (42%): Gram-negative bacteria in 54 (81.8%), Gram-positive in 11 (16.7%), and Candida in 1. Isolated Gram-negative organisms were resistant to third-generation cephalosporin in 6 cases (17%), to ciprofloxacin in 11 (20.8%), and to penicillin in 33 (62.3%). The treatment failure and in-hospital mortality rates were 12.1% and 21%, respectively. A high Model of End-Stage Liver Disease (MELD) score, SBP caused by extended-spectrum β-lactamase-producing organisms, and hepatocellular carcinoma were independent prognostic factors of high in-hospital mortality. Conclusions: SBP remains to be a serious complication with high in-hospital mortality, especially in patients with a high MELD score.

참고문헌 (46)

  1. Runyon BA, "Spontaneous bacterial peritonitis: an explosion of information", Hepatology, 8, pp.171~175 (1988)
  2. Such J, "Spontaneous bacterial peritonitis", Clin Infect Dis, 27, pp.669~674 (1998)
  3. Fernandez J, "Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis", Hepatology, 35, pp.140~148 (2002)
  4. Pinzello G, "Spontaneous bacterial peritonitis: a prospective investigation in predominantly nonalcoholic cirrhotic patients", Hepatology, 3, pp.545~549 (1983)
  5. Cirera I, "Bacterial translocation of enteric organisms in patients with cirrhosis", J Hepatol, 34, pp.32~37 (2001)
  6. Berg RD, "Bacterial translocation from the gastrointestinal tract", Adv Exp Med Biol, 473, pp.11~30 (1999)
  7. Guarner C, "Bacterial translocation and its consequences in patients with cirrhosis", Eur J Gastroenterol Hepatol, 17, pp.27~31 (2005)
  8. Wiest R, "Bacterial translocation (BT) in cirrhosis", Hepatology, 41, pp.422~433 (2005)
  9. Runyon BA, "Early events in spontaneous bacterial peritonitis", Gut, 53, pp.782~784 (2004)
  10. De Fernandez MA, "Neutrophil phagocytic and bactericidal function in primary biliary cirrhosis and other chronic liver diseases", Clin Exp Immunol, 67, pp.655~661 (1987)
  11. Fiuza C, "Granulocyte colony-stimulating factor improves deficient in vitro neutrophil transendothelial migration in patients with advanced liver disease", Clin Diagn Lab Immunol, 9, pp.433~439 (2002)
  12. Runyon BA, "Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis", Gastroenterology, 91, pp.1343~1346 (1986)
  13. Tito L, "Recurrence of spontaneous bacterial peritonitis in cirrhosis: frequency and predictive factors", Hepatology, 8, pp.27~31 (1988)
  14. Guarner C, "Risk of a first community- acquired spontaneous bacterial peritonitis in cirrhotics with low ascitic fluid protein levels", Gastroenterology, 117, pp.414~419 (1999)
  15. Kerr DN, "Infection of ascitic fluid in patients with hepatic cirrhosis", Gut, 4, pp.394~398 (1963)
  16. Conn HO, "Spontaneous peritonitis and bacteremia in Laennec's cirrhosis caused by enteric organisms: a relatively common but rarely recognized syndrome", Ann Intern Med, 60, pp.568~580 (1964)
  17. Felisart J, "Cefotaxime is more effective than is ampicillin-tobramycin in cirrhotics with severe infections", Hepatology, 5, pp.457~462 (1985)
  18. Toledo C, "Spontaneous bacterial peritonitis in cirrhosis: predictive factors of infection resolution and survival in patients treated with cefotaxime", Hepatology, 17, pp.251~257 (1993)
  19. Llovet JM, "Short-term prognosis of cirrhotics with spontaneous bacterial peritonitis: multivariate study", Am J Gastroenterol, 88, pp.388~392 (1993)
  20. Follo A, "Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis", Hepatology, 20, pp.1495~1501 (1994)
  21. Rimola A, "Two different dosages of cefotaxime in the treatment of spontaneous bacterial peritonitis in cirrhosis: results of a prospective, randomized, multicenter study", Hepatology, 21, pp.674~679 (1995)
  22. Sort P, "Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis", N Engl J Med, 341, pp.403~409 (1999)
  23. Gines P, "Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: results of a double-blind, placebo-controlled trial", Hepatology, 12, pp.716~724 (1990)
  24. Rolachon A, "Ciprofloxacin and long-term prevention of spontaneous bacterial peritonitis: results of a prospective controlled trial", Hepatology, 22, pp.1171~1174 (1995)
  25. Terg R, "Effects of oral ciprofloxacin on aerobic gram-negative fecal flora in patients with cirrhosis: results of short- and long-term administration, with daily and weekly dosages", J Hepatol, 29, pp.437~442 (1998)
  26. Singh N, "Trimethoprim- sulfamethoxazole for the prevention of spontaneous bacterial peritonitis in cirrhosis: a randomized trial", Ann Intern Med, 122, pp.595~598 (1995)
  27. Dupeyron C, "Rapid emergence of quinolone resistance in cirrhotic patients treated with norfloxacin to prevent spontaneous bacterial peritonitis", Antimicrob Agents Chemother, 38, pp.340~344 (1994)
  28. Yamaguchi K, "Evaluation of the in vitro activity of six broad-spectrum beta-lactam antimicrobial agents tested against over 2,000 clinical isolates from 22 medical centers in Japan. in: Japan Antimicrobial Resistance Study Group", Diagn Microbiol Infect Dis, 34, pp.123~134 (1999)
  29. Jones RN, "Epidemiologic trends in nosocomial and community-acquired infections due to antibiotic- resistant gram-positive bacteria: the role of streptogramins and other newer compounds", Diagn Microbiol Infect Dis, 33, pp.101~112 (1999)
  30. Goossens H, "European status of resistance in nosocomial infections", Chemotherapy, 51, pp.177~181 (2005)
  31. Park YH, "Recent increase in antibiotic- resistant microorganisms in patients with spontaneous bacterial peritonitis adversely affects the clinical outcome in Korea", J Gastroenterol Hepatol, 18, pp.927~933 (2003)
  32. Guarner C, "Spontaneous bacterial peritonitis", Semin Liver Dis, 17, pp.203~217 (1997)
  33. Akriviadis EA, "Utility of an algorithm in differentiating spontaneous from secondary bacterial peritonitis", Gastroenterology, 98, pp.127~133 (1990)
  34. Aparicio JR, "Development of quinolone- resistant strains of Escherichia coli in stools of patients with cirrhosis undergoing norfloxacin prophylaxis: clinical consequences", J Hepatol, 31, pp.277~283 (1999)
  35. Runyon BA, "Optimization of ascitic fluid culture technique", Gastroenterology, 95, pp.1351~1355 (1988)
  36. National Commettee for Clinical Laboratory Standards, "Performance standard for antimicrobial disk susceptibility test: approved standard M2-A6. Vallanova: National Committee for Clinical Laboratory Standars", ~ (1997)
  37. Kamath PS, "A model to predict survival in patients with end-stage liver disease", Hepatology, 33, pp.464~470 (2001)
  38. Ricart E, "Amoxicillin-clavulanic acid versus cefotaxime in the therapy of bacterial infections in cirrhotic patients", J Hepatol, 32, pp.596~602 (2000)
  39. Correia JP, "Spontaneous bacterial peritonitis in cirrhosis: endemic or epidemic?", Med Clin North Am, 59, pp.963~981 (1975)
  40. Runyon BA, "Culture-negative neutrocytic ascites: a variant of spontaneous bacterial peritonitis", Hepatology, 4, pp.1209~1211 (1984)
  41. Cho JH, "Bacteremia is a prognostic factor for poor outcome in spontaneous bacterial peritonitis", Scand J Infect Dis, 39, pp.697~702 (2007)
  42. Cholongitas E, "Increasing frequency of Gram-positive bacteria in spontaneous bacterial peritonitis", Liver Int, 25, pp.57~61 (2005)
  43. Evans LT, "Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites", Hepatology, 37, pp.897~901 (2003)
  44. Grange JD, "Norfloxacin primary prophylaxis of bacterial infections in cirrhotic patients with ascites: a double-blind randomized trial", J Hepatol, 29, pp.430~436 (1998)
  45. Novella M, "Continuous versus inpatient prophylaxis of the first episode of spontaneous bacterial peritonitis with norfloxacin", Hepatology, 25, pp.532~536 (1997)
  46. Runyon BA, "Management of adult patients with ascites due to cirrhosis", Hepatology, 39, pp.841~856 (2004)

관련 논문AI추천

Predictive factors that influence the survival rates in liver cirrhosis patients with spontaneous bacterial peritonitis김유선, Hee Won Cho, In Hye Cha, Jeong Seop Moon, Jin Nam Kim, Pei Chuan Tsung, Soo Hyung Ryu대한간학회 · Clinical and Molecular Hepatology2013 · 제19권 제2호최근 12년간 발생한 자발성 세균성 복막염의 균주와 항생제 내성의 변화김정한, 김지훈, 변관수, 서상준, 연종은, 이순재, 임형준, 정영걸, 주문경대한내과학회 · 대한내과학회지2008 · 제75권 제1호Clinical impact of healthcare-associated acquisition in cirrhotic patients with community-onset spontaneous bacterial peritonitisCheol-In Kang, Doo Ryeon Chung, Geum-Youn Gwak, Jae-Hoon Song, Jungok Kim, Kyong Ran Peck대한내과학회 · The Korean Journal of Internal Medicine2020 · 제35권 제1호최근 5년 사이에 발생한 자발성 세균성 복막염의 임상 양상과 배양 균주 및 항균제 내성 추이류수형, 박영환, 서동진, 송희곤, 신정우, 이영상, 이윤정, 이한주, 정세라, 정영화, 주연호대한간학회 · Clinical and Molecular Hepatology2002 · 제8권 제2002호The Effect of the First Spontaneous Bacterial Peritonitis Event on the Mortality of Cirrhotic Patients with Ascites: A Nationwide Population-Based Study in TaiwanChen-Chi Tsai, Chih-Chun Tsai, Chih-Wei Tseng, Kuo-Chih Tseng, Tsung-Hsing Hung, Yu-Hsi Hsieh거트앤리버 소화기연관학회협의회 · Gut and Liver2016 · 제10권 제5호자발성 세균성 복막염 환자의 진단에 있어서 시험지봉(Reagent Strips)검사의 유용성김기덕, 김대겸, 김성훈, 서동진, 이영상, 이한주, 임영석, 정영화, 최원범대한간학회 · Clinical and Molecular Hepatology2005 · 제11권 제2005호

이 간행물의 다른 논문 (14건)