title: [Spontaneous bacterial peritonitis: a severe complication of liver cirrhosis].
abstract: Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication of decompensated cirrhosis. SBP is defined as an infection of initially sterile ascitic fluid (AF) without a detectable, surgically treatable source of infection.
  
  
  OBJECTIVE
  To evaluate the prevalence, incidence, pathogens and clinical outcome of patients with liver cirrhosis and SBP.
  
  
  METHODS
  A prospective study evaluated 34 episodes of SBP developed in 29 patients with cirrhosis and ascites admitted in hospital. 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 group was 56.89 +/- 8.79 years, more frequently occurred in men 21 of 29 cases (72.41%). Microorganisms were isolated in 12 episodes (35.29%): Gram-negative bacteria in 8 (66.67%) and Gram-positive in 4 (33.33%). The first-line treatment failure and in-hospital mortality rates were 26.47% and 17.64%, respectively. The low in-hospital mortality seems to be related to earlier diagnosis and treatment. In the multivariate analysis, three significant independent predictive factors of in-hospital mortality were identified: a high Model of End-Stage Liver Disease (MELD) score, renal failure and SBP caused by extended-spectrum a-lactamase-producing organisms. The relapse rate of PBS was 21.73%.
  
  
  CONCLUSIONS
  SBP remains to be a serious complication, especially in patients with a high MELD score. Ceftazidim represents a good choice in empirical treatment of SBP.
authors.affiliation: Facultatea de Medicină Institutul de Gastroenterologie si Hepatologie, Universitatea de Medicină si Farmacie "Gr.T. Popa" Iaşi.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Balan
authors.forename: Anca
authors.initials: A
authors.lastname: Trifan
authors.forename: D
authors.initials: D
authors.lastname: Botezatu
authors.forename: Carmen
authors.initials: C
authors.lastname: Anton
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001202:Ascitic Fluid / Q000382:microbiology; D042241:Early Diagnosis; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D016908:Gram-Positive Bacterial Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012383:Romania / Q000453:epidemiology; D015996:Survival Rate
chemical_list: D000900:Anti-Bacterial Agents