Premium
The prevalence and prognostic significance of spontaneous bacterial peritonitis in severe acute hepatitis with ascites
Author(s) -
Chu ChiaMing,
Chiu KingWah,
Liaw YunFan
Publication year - 1992
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.1840150509
Subject(s) - spontaneous bacterial peritonitis , ascites , medicine , bacteremia , peritonitis , gastroenterology , mortality rate , microbiological culture , sepsis , microbiology and biotechnology , antibiotics , bacteria , biology , genetics
The prevalence and prognostic significance of spontaneous bacterial peritonitis were prospectively studied in a series of 82 acute hepatitis patients decompensated with ascites. The in‐hospital prevalence of spontaneous bacterial peritonitis was 31.7% (26 of 82 patients). Twenty cases were culture positive, including one with multiple isolates, and six cases were culture negative. E. coli and Klebsiella pneumoniae were the most common pathogens, accounting for 71.4% (15 of 21) of the total isolates, whereas only 9.5% were gram‐positive organisms. No significant difference in the age, sex, cause of acute hepatitis, liver biochemistry, prothrombin time and ascites fluid concentration of total protein was noted between patients with spontaneous bacterial peritonitis and those without spontaneous bacterial peritonitis, except that bacteremia was recognized significantly more frequently in the former (57.7% or 15 of 26 patients) than in the latter (25.0% or 14 of 56 patients, p < 0.005). In addition, patients with spontaneous bacterial peritonitis, when compared with those without spontaneous bacterial peritonitis, were more likely to have kidney failure (57.7% vs. 30.4%, p < 0.05) and gastrointestinal hemorrhage (53.8% vs. 30.4%, p < 0.05) and had a significantly higher mortality rate (73.1% vs. 39.3%, p > 0.01). Among patients without spontaneous bacterial peritonitis, the prevalence of kidney failure and gastrointestinal hemorrhage and the mortality rate in patients with bacteremia (57.1%, 64.3% and 71.4%, respectively) were significantly higher than in those without bacteremia (21.4%, 19.0% and 28.6%, respectively; p < 0.05, p < 0.01 and p < 0.01, respectively). In conclusion, 31.7% of severe acute hepatitis patients with ascites were recognized as having spontaneous bacterial peritonitis; the other 17.1% had bacteremia. Patients with spontaneous bacterial peritonitis, bacteremia or both had high morbidity and mortality rates. Whether prophylactic antimicrobial therapy might be justified in patients with severe acute hepatitis awaits further study. (H EPATOLOGY 1992;15:799–803).