Clinical Features and Outcomes of Spontaneous Bacterial Peritonitis Caused by Streptococcus pneumoniae: A Matched Case-Control Study.
Streptococcus pneumoniae is a well-known cause of spontaneous bacterial peritonitis (SBP) in cirrhotic patients. However, little information is available regarding clinical characteristics and outcomes of SBP caused by S. pneumoniae. It has been suggested that spontaneous pneumococcal peritonitis (SPP) often spreads hematogenously from concomitant pneumococcal pneumonia, and is associated with a higher rate of mortality.During the period between January 1997 and December 2013, 50 SPP cases were identified. These cases were then age/sex-matched with 100 patients with SBP due to causes other than S. pneumoniae (controls).SPP accounted for 4.3% (50/1172) of all culture-proven SBPs. The baseline Child-Pugh class, etiology of cirrhosis, and model for end-stage liver disease scores were comparable for the 2 groups. SPP patients were more likely than control patients to have a community-acquired infection (90.0% vs. 76.0%; P = 0.04), concurrent bacteremia (84.0% vs. 59.0%; P = 0.002), and to present with variceal bleeding (10.0% vs. 1.0%; P = 0.02). None of the study patients had pneumococcal pneumonia. The most common initial empirical therapy for both groups was third-generation cephalosporins (96.0% vs. 91.0%; P = 0.34) which was active against a significantly higher proportion of the cases than of the controls (97.8% vs. 78.7%; P = 0.003). Thirty-day mortality was significantly lower in the case group than in the control group (10.0% vs. 24.0%; P = 0.04).SPP was not associated with pneumococcal pneumonia and showed lower mortality than SBP caused by other organisms. However, the present study was constrained by the natural limitations characteristic of a small, retrospective study. Therefore, large-scale, well-controlled studies are required to demonstrate the influence of SPP on mortality, which was marginal in the present study.
From the Department of Infectious Diseases (TK, SIH, SYP, JJ, YPC, S-HK, S-OL, YSK, JHW, S-HC); Department of Gastroenterology (Y-SL); and Department of Laboratory Medicine (HS, M-NK), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Taeeun
T
Kim
Sun In
SI
Hong
Se Yoon
SY
Park
Jiwon
J
Jung
Yong Pil
YP
Chong
Sung-Han
SH
Kim
Sang-Oh
SO
Lee
Yang Soo
YS
Kim
Jun Hee
JH
Woo
Young-Suk
YS
Lim
Heungsup
H
Sung
Mi-Na
MN
Kim
Sang-Ho
SH
Choi
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000453:epidemiology; D015897:Comorbidity; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology; D013296:Streptococcus pneumoniae
D000900:Anti-Bacterial Agents