Etiology and mortality of spontaneous bacterial peritonitis in liver transplant recipients: a cohort study.
Spontaneous bacterial peritonitis (SBP) in liver transplantation (LT) recipients who progress to cirrhosis has received little attention. We investigated the adequacy of empirical treatment with third-generation cephalosporins for SBP in this population and the impact of transplantation on the evolution of the infection. We performed a cohort study with 138 SBP episodes: 19 in LT patients and 119 in non-LT patients. The etiology of SBP was identified for 73.7% of the episodes in LT patients and for 38.7% of the episodes in non-LT patients (P = 0.004). The main microorganisms in recipients were Escherichia coli (35.7%) and Streptococcus pneumoniae (21.4%). The etiologies did not differ in non-LT patients. The cephalosporin sensitivity was similar in the 2 groups (85.7% versus 78.4%, P = 0.7). LT recipients developed renal failure (57.9% versus 25.2%, P = 0.004) and encephalopathy (42.1% versus 22%, P = 0.08) more often than non-LT patients, and the mortality rates during episodes (52.6% versus 13.4%, P < 0.001) and at 6 months (70.6% versus 34.7%, P = 0.005) were higher. According to a multivariate analysis, the mortality-associated risk factors at diagnosis were a Model for End-Stage Liver Disease (MELD) score > 18 odds ratio (OR) = 6.1 and being an LT recipient (OR = 4.45). At 6 months, the risk factors for mortality were a MELD score > 18 (OR = 3.08), being an LT recipient (OR = 3.47), a known etiology (OR = 2.08), and the presence of hepatocellular carcinoma (OR = 3.73).
Liver Unit, Department of Internal Medicine, Vall d'Hebron Hospital, Barcelona, Spain.
Cristina
C
Pérez-Cameo
Víctor
V
Vargas
Lluís
L
Castells
Itxarone
I
Bilbao
Isabel
I
Campos-Varela
Joan
J
Gavaldà
Albert
A
Pahissa
Oscar
O
Len
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000382:microbiology / Q000601:surgery*; D002511:Cephalosporins / Q000494:pharmacology; D015331:Cohort Studies; D058625:End Stage Liver Disease / Q000150:complications* / Q000601:surgery*; D004926:Escherichia coli; D005260:Female; D006501:Hepatic Encephalopathy; D006801:Humans; D008113:Liver Neoplasms / Q000382:microbiology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010538:Peritonitis / Q000209:etiology / Q000382:microbiology*; D011184:Postoperative Period; D051437:Renal Insufficiency; D012307:Risk Factors; D013296:Streptococcus pneumoniae
D002511:Cephalosporins