Aeromonas spontaneous bacterial peritonitis: a highly fatal infectious disease in patients with advanced liver cirrhosis.
OBJECTIVE
Aeromonas infections, rarely reported in Western countries, are not uncommon infectious diseases in Taiwan. The clinical manifestations and prognostic factors of Aeromonas spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis were investigated.


METHODS
We reviewed the medical charts and microbiological records of liver cirrhosis patients with Aeromonas SBP between January 1990 and December 2005, in a medical center in southern Taiwan.


RESULTS
Thirty-one liver cirrhosis patients developed Aeromonas SBP within a 16-year period. The majority (26, 84%) had concurrent Aeromonas bacteremia. A. sobria (55%) and A. hydrophila (45%) were the causative species. The predominant clinical manifestations included fever (84%), abdominal pain (74%), hypotension on admission (48%), altered mental status (45%), and acute renal failure (42%). Gram-negative bacilli were found in Gram staining of ascitic fluids in 27% of 26 patients, while aeromonads were isolated from ascitic fluids in 55% of 31 patients. The yield rate of ascitic fluid cultures decreased greatly, if paracentesis was performed at > 3 hours after the administration of antimicrobial therapy. All but one patient received in-vitro-active antimicrobial agents within 48 hours, but the all-cause mortality rate was 56%. Initial high Pitt's bacteremia score was independently associated with a fatal outcome in multivariate analysis.


CONCLUSIONS
Aeromonas SBP is a fatal disease, and must be included in the differential diagnosis of SBP in patients with advanced liver cirrhosis in endemic areas.
Wu
Chi-Jung
CJ
Graduate Institute of Clinical Medicine, National Cheng Kung University, Medical College, Tainan, Taiwan.
Lee
Hsin-Chun
HC
Chang
Ting-Tsung
TT
Chen
Chiung-Yu
CY
Lee
Nan-Yao
NY
Chang
Chia-Ming
CM
Sheu
Bor-Shyang
BS
Cheng
Pin-Nan
PN
Shih
Hsin-I
HI
Ko
Wen-Chien
WC
D000328:Adult; D000333:Aeromonas; D000368:Aged; D000369:Aged, 80 and over; D001202:Ascitic Fluid / Q000382:microbiology; D003937:Diagnosis, Differential; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors