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Etiology and mortality of spontaneous bacterial peritonitis in liver transplant recipients: A cohort study
Author(s) -
PérezCameo Cristina,
Vargas Víctor,
Castells Lluís,
Bilbao Itxarone,
CamposVarela Isabel,
Gavaldà Joan,
Pahissa Albert,
Len Oscar
Publication year - 2014
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.23889
Subject(s) - spontaneous bacterial peritonitis , medicine , liver transplantation , etiology , gastroenterology , odds ratio , hepatic encephalopathy , liver disease , cirrhosis , transplantation , cohort , population , surgery , environmental health
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 Transpl 20:856–863, 2014 . © 2014 AASLD.