Spontaneous bacterial peritonitis in patients with hepatic cirrhosis: evaluation of a treatment protocol at specialized units.
BACKGROUND
Spontaneous bacterial peritonitis is a common and severe complication in patients with cirrhosis and ascitis. Its prognosis clearly depends on its precocious clinical recognition and efficacious therapy.


OBJECTIVE
To optimize a treatment protocol, after auditing clinical efficacy and describe microorganisms implicated at our institution.


METHODS
Retrospective study of clinical files of patients with hepatic cirrhosis with positive culture of ascitic fluid (AF) and/or an AF polymorphonuclear (PMN) count of more than 250/mm3, treated at our units between 1st January, 2000 and 31st December, 2001 (n = 38). Patients showed a median age of 49 years (30-76), 63% of which were male. Forty-eight percent were classified as belonging to Child-Pugh B class, and 52% to C.


RESULTS
First, considering cases with PMN > 250/mm3 (n = 29), antibiotics were given to all patients (cefotaxime and ampiciline). Fifty-two percent had hepatic encephalopathy, 42% had fever, 66% abdominal pain. In 42% a microorganism was isolated. Although 24% of fatal cases (only two related to infection), we noted a 73% clinical and laboratorial response. Five patients (72%) that died, showed renal failure by the time of death. Second, in all cases with positive culture of ascitic fluid (n = 21), 42% of which with PMN > 250/mm3 and 9 monobacterial nonneutrocytic bacterascites' cases, one only agent was found: E. coli in 36%, Streptococci (37%), Staphylococci (14%), and other (14%): Klebsiella oxytoca, n = 1; Salmonella enteritidis, n = 1; Enterococcus faecium, n = 1, Acinectobacter anitratus, n = 1. Only one of the agents, E. faecium (3%) showed in vitro sensitivity exclusively to ampiciline; all other were cefotaxime sensitivite.


CONCLUSIONS
Our protocol will be modified, to treat patients with spontaneous bacterial peritonitis with cefotaxime, as monotherapy. Albumin infusion will also be added to the protocol, as, we found renal failure to be an important negative prognosis factor.
Dinis-Ribeiro
M
M
Liver Unit and Hepatology and Gastroenterology Intensive Care Unit, Department of Medicine II, University Hospital of Santa Maria, Lisbon, Portugal.
Cortez-Pinto
H
H
Marinho
R
R
Valente
A
A
Raimundo
M
M
Salgado
M J
MJ
Ramalho
F
F
Alexandrino
P
P
Carneiro-de-Moura
M
M
D000328:Adult; D000368:Aged; D000667:Ampicillin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D002439:Cefotaxime / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003627:Data Interpretation, Statistical; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010406:Penicillins / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D010538:Peritonitis / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D010406:Penicillins; D000667:Ampicillin; D002439:Cefotaxime