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Spontaneous bacterial peritonitis. Clinical and microbiological study of 233 episodes
D Boixeda1, D A De Luis, R Aller
1Hospital Ramón Y Cajal, Department of Gastroenterology, University of Alcala de Henares, Madrid, Spain.
Abstract:
We made a retrospective study of 233 episodes of spontaneous bacterial peritonitis that were treated at our Service between January 1980 and September 1996 in order to analyze the clinical presentation, microbiological data, possible pathogenic factors, treatment, and evolution of this clinical entity. Ascites, abdominal pain, and fever were the most frequent symptoms. Only 3.43% of the episodes developed asymptomatically. Thirty-six episodes resulted in the patient's death (15.45%) and, of all the factors analyzed, only a prothrombin time of < 35%, bilirubin > 8 mg/dl, and serum creatinine > 2.1 mg/dl were statistically correlated with a higher death rate. The culture of the ascitic fluid gave a positive result in 47.6% of the cases, whereas no clinical differences were noticed between these patients and those with negative results. The most frequently isolated microorganisms turned out to be Gram negative (49.54%). A proportion of 71.24% of the episodes were treated with cephotaxime (i.v.), whereas 28.76% were treated with other drugs or pharmacological combinations. The death rate was much lower with cephotaxime (4.81% vs. 41.79%, p < 0.01%).
Insights
Spontaneous bacterial peritonitis (SBP) treatment with ceftriaxone significantly reduced mortality. SBP symptoms include ascites, pain, and fever, with Gram-negative bacteria being common pathogens.
Area of Science:
- Hepatology
- Infectious Diseases
- Internal Medicine
Background:
- Spontaneous bacterial peritonitis (SBP) is a serious complication of advanced liver disease.
- Understanding SBP's clinical presentation, microbiology, and treatment outcomes is crucial for patient management.
Purpose of the Study:
- To analyze the clinical features, microbiology, risk factors, treatment strategies, and outcomes of spontaneous bacterial peritonitis.
- To evaluate the efficacy of ceftriaxone compared to other treatments for SBP.
Main Methods:
- Retrospective study of 233 SBP episodes treated between January 1980 and September 1996.
- Analysis of clinical presentation, microbiological data, mortality predictors, and treatment regimens.
- Comparison of mortality rates between ceftriaxone and other treatments.
Main Results:
- Ascites, abdominal pain, and fever were the most common symptoms; 3.43% of episodes were asymptomatic.
- Mortality rate was 15.45%. Factors predicting higher mortality included low prothrombin time, elevated bilirubin, and high serum creatinine.
- Gram-negative bacteria were the most frequent pathogens (49.54%).
- Ceftriaxone (71.24% of cases) was associated with significantly lower mortality (4.81%) compared to other treatments (41.79%, p < 0.01%).
Conclusions:
- Ceftriaxone is a highly effective treatment for spontaneous bacterial peritonitis, significantly reducing mortality rates.
- Clinical and laboratory parameters can predict mortality risk in SBP patients.
- Prompt and appropriate antibiotic therapy is essential for improving SBP outcomes.