A sequential study of serum bacterial DNA in patients with advanced cirrhosis and ascites (original) (raw)

A Profile of Spontaneous Bacterial Peritonitis and Its Variants in Cases of Liver Cirrhosis

2017

notorious for its high recurrence rates and is frequently associated with short term as well as long term mortality in the affected patients. Objective: To analyse the incidence, clinical and bacteriological profile of patients with spontaneous bacterial peritonitis or its variants such as culture negative neutrocytic ascites and bacterascites in cases of liver cirrhosis. Patients with SBP or its variants were compared to patients with Non SBP Ascites in order to assess the predictive factors for the development of SBP or its variants and thereby relate the in hospital mortality in these patients with various possible parameters. Methods: The present study was a prospective, cross sectional, comparative study conducted among 60 patients with ascites due to liver cirrhosis fulfilling the proposed inclusion and exclusion criteria, admitted at MGM Medical College and Hospital, Navi Mumbai, between November 2014 and November 2016. Ascitic fluid routine and culture analysis with antibiot...

[Spontaneous bacterial peritonitis: a severe complication of liver cirrhosis]

Revista medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti din Iaş̧i

Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication of decompensated cirrhosis. SBP is defined as an infection of initially sterile ascitic fluid (AF) without a detectable, surgically treatable source of infection. To evaluate the prevalence, incidence, pathogens and clinical outcome of patients with liver cirrhosis and SBP. A prospective study evaluated 34 episodes of SBP developed in 29 patients with cirrhosis and ascites admitted in hospital. SBP was diagnosed based on a polymorphonuclear cell count in ascitic fluid of > 250 cells/mm3 in the absence of data compatible with secondary peritonitis. The mean age of the group was 56.89 +/- 8.79 years, more frequently occurred in men 21 of 29 cases (72.41%). Microorganisms were isolated in 12 episodes (35.29%): Gram-negative bacteria in 8 (66.67%) and Gram-positive in 4 (33.33%). The first-line treatment failure and in-hospital mortality rates were 26.47% and 17.64%, respectively. The low in-hospital mortal...

Spontaneous bacterial peritonitis in patients with hepatic cirrhosis: evaluation of a treatment protocol at specialized units

Revista española de enfermedades digestivas : organo oficial de la Sociedad Española de Patología Digestiva, 2002

Spontaneous bacterial peritonitis is a common and severe complication in patients with cirrhosis and ascitis. Its prognosis clearly depends on its precocious clinical recognition and efficacious therapy. To optimize a treatment protocol, after auditing clinical efficacy and describe microorganisms implicated at our institution. Retrospective study of clinical files of patients with hepatic cirrhosis with positive culture of ascitic fluid (AF) and/or an AF polymorphonuclear (PMN) count of more than 250/mm3, treated at our units between 1st January, 2000 and 31st December, 2001 (n = 38). Patients showed a median age of 49 years (30-76), 63% of which were male. Forty-eight percent were classified as belonging to Child-Pugh B class, and 52% to C. First, considering cases with PMN > 250/mm3 (n = 29), antibiotics were given to all patients (cefotaxime and ampiciline). Fifty-two percent had hepatic encephalopathy, 42% had fever, 66% abdominal pain. In 42% a microorganism was isolated. A...

Spontaneous bacterial peritonitis and extraperitoneal infections in patients with cirrhosis

Annals of Hepatology, 2020

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Bacterial DNA in patients with cirrhosis and noninfected ascites mimics the soluble immune response established in patients with spontaneous bacterial peritonitis

Hepatology, 2008

Bacterial infections and severity of associated inflammatory reaction influence prognosis in patients with advanced cirrhosis. We compared the innate immune response to bacterial DNA (bactDNA) translocation with that caused by viable bacteria translocation in patients with spontaneous bacterial peritonitis and the relationship between the cytokine response and serum levels of bactDNA. The bactDNA translocation was investigated in 226 patients with cirrhosis and noninfected ascites, 22 patients with spontaneous bacterial peritonitis, and 10 patients with ascites receiving continuous norfloxacin. Serum and ascitic fluid tumor necrosis factor ␣, interferon-␥, interleukin-12, and nitric oxide metabolites were measured via enzyme-linked immunosorbent assay. Bacterial genomic identifications were made via amplification and sequencing of the 16S ribosomal RNA gene and digital quantization with DNA Lab-on-chips. The bactDNA was present in 77 noninfected patients (34%) and in all cases of spontaneous bacterial peritonitis, even in those with culture-negative ascitic fluid. No patient receiving norfloxacin showed bactDNA translocation. Levels of all cytokines were similar in patients with bactDNA translocation or spontaneous bacterial peritonitis and significantly higher than in patients without bactDNA or in those receiving norfloxacin. Serum bactDNA concentration paralleled levels of all cytokines and nitric oxide in a series of patients with bactDNA translocation or spontaneous bacterial peritonitis followed during 72 hours. Antibiotic treatment in the series of patients with spontaneous bacterial peritonitis did not abrogate bactDNA translocation in the short term. Conclusion: bactDNA translocation-associated cytokine response is indistinguishable from that in patients with spontaneous bacterial peritonitis and is dependent on bactDNA concentration. Norfloxacin abrogates bactDNA translocation and cytokine response. (HEPATOLOGY 2008;47:978-985.)

Spontaneous bacterial peritonitis: How to deal with this life-threatening cirrhosis complication?

Therapeutics and clinical risk management, 2008

Spontaneous bacterial peritonitis (SBP) is one of the most common and life-threatening complications of cirrhosis. It occurs in 10% to 30% of patients admitted to hospital and recent studies tend to demonstrate that SBP incidence seems to be decreasing in its frequency. A bacterial overgrowth with translocation through the increased permeable small intestinal wall and impaired defense mechanisms is considered to be the main mechanism associated with its occurrence. The Gram-negative aerobic bacteria are the major responsible for SBP episodes and Gram-positive bacteria, mainly Staphylococcus aureus, are being considered an emergent agent causing SBP. The prompt diagnosis of SBP is the key factor for reduction observed in mortality rates in recent years. The clinical diagnosis of SBP is neither sensitive nor specific and the search for new practical and available tools for a rapid diagnosis of SBP is an important endpoint of current studies. Reagent strips were considered a promising ...

Diagnosis and management of bacterial infections in decompensated cirrhosis

World journal of hepatology, 2013

Bacterial infections are one of the most frequent complications in cirrhosis and result in high mortality rates. Patients with cirrhosis have altered and impaired immunity, which favours bacterial translocation. Episodes of infections are more frequent in patients with decompensated cirrhosis than those with compensated liver disease. The most common and life-threatening infection in cirrhosis is spontaneous bacterial peritonitis followed by urinary tract infections, pneumonia, endocarditis and skin and soft-tissue infections. Patients with decompensated cirrhosis have increased risk of developing sepsis, multiple organ failure and death. Risk factors associated with the development of infections are severe liver failure, variceal bleeding, low ascitic protein level and prior episodes of spontaneous bacterial peritonitis (SBP). The prognosis of these patients is closely related to a prompt and accurate diagnosis. An appropriate treatment decreases the mortality rates. Preventive str...