Variant of Ascitic Fluid Bacterial Infections in Patients of Liver Cirrhosis (original) (raw)
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https://www.ijrrjournal.com/IJRR\_Vol.7\_Issue.12\_Dec2020/Abstract\_IJRR0084.html, 2020
Background: Spontaneous ascitic fluid infection (SAI) is common in cirrhotic patients. Third-generation cephalosporins are currently recommended as first-line therapy. We conducted a study to determine bacterial etiology, susceptibility patterns. Objective: To estimate the prevalence of spontaneous ascitic fluid infection in cirrhotic decompensated liver disease patients, and to analyse microbiological profile in cirrhotic ascites. Method: We prospectively collected clinical data and laboratory values. Diagnostic paracentesis was performed in all patients of decompensated cirrhotic liver disease with ascites to investigate the presence of SAI. Result: Among total 45 patients the leading cause of cirrhosis was alcohol consumption. SAI was diagnosed in 27 patients (60%). Of these, 19 patients (70 %) had culture negative neutrocytic ascites (CNNA), 5 (18.5%) had Spontaneous bacterial peritonitis (SBP), and 3 (11.1%) had mono microbial non neutrocytic bacterascites (MNB). CNNA and SBP did not differ in terms of clinical characteristics. Organisms found are-two Streptococci and two coagulase negative staphylococci, two E. coli, one klebsiella pneumonia, one candida growth. Gram positive cocci (50%) were predominant among culture positive SAI, gram negative bacilli (37.5%), fungus (12.5%). Among the commonly used antibiotics higher resistance rate was found with cephalosporins (71.4%) and most sensitive antibiotics found to be carbapenems, linezolid, vancomycin (85%), then amino glycosides and tetracycline (71%)
2018
Objective: Our aim of this research was to investigate the incidence of spontaneous bacterial peritonitis (SBP) in cirrhotic ascites patients. Methods: We completed this particular research on a total of one hundred cirrhotic ascites patients at Bahawal Victoria Hospital Bahawalpur from March to December 2017. History and clinical assessment helped in the study of SBP. The diagnosis was possible through cell PMN count of ascitic fluid (more than 250 / mm 3) OR. There was an absence of primary infection source and positive culturing of ascitic fluid. Results: We reported Cirrhosis after Alcoholism with dominance in the male participants as only 14 females reported against 86 males with a male to female respective proportion 86% and 14%. The only male population had the incidence of SBP. The mean age of patients and SBP diagnosed patients was respectively 49.10 years and 50.58 years. In the total eighteen positive cases of SBP, fourteen had a count of PMN above 250 / mm 3. E. Coli and positive staph aureus were respectively in three and one participants. During the SBP diagnosis research vomiting and fever was among 66% of the SBP diagnosed cases. Every case of abdomen pain and altered sensorium was SBP positive. No fever was in about 2.5% SBP positive cases. During the investigations of SBP associated clinical symptoms, every patient had abdominal tenderness. While making a comparison of positive Child-Pugh grading with an increase in the severity SBP also increased and there were 13 cases out of 18 with a proportion of (85.71%) who had an association with Child-Pugh Class-C; whereas, in Class-B only five cases with a proportion of (7.8%). About forty-four percent cases had a level of Ascitic Fluid Protein under (1 g/dl). The most common type of SBP was CNNA as it was available in fifteen cases (83.3 %). Conclusion: About eighteen percent of cirrhotic ascites patients had the infection of ascitic fluid which was a possible reason for SBP incidence. All the patients who presented general condition deterioration were commonly due to higher liver function derangement as the chances of SBP also increase. Level of Ascitic Protein less than (1 g/dl) in the patients may likely present the incidence of SBP than the patients having AF protein more than (1 g/dl). Cirrhosis severity increases with an increased development of SBP and also with the judged cirrhotic severity with Child-Pugh Class.
Detection of ascitic fluid infections in patients with liver cirrhosis and ascites
Arab Journal of Gastroenterology, 2011
Background and study aims: Ascitic fluid infections (AFIs) are the frequent complications of advanced liver disease. Bacterial translocation is considered a key step in the pathogenesis of gut-derived bacterial infections; mainly spontaneous bacterial peritonitis (SBP) in cirrhotic patients. Bacterial DNA (bactDNA) in ascitic fluid and serum has been suggested as a surrogate marker for bacterial translocation. We attempted at the isolation and identification of bacteria in ascitic fluid in cirrhotic patients and the assessment of polymerase chain reaction (PCR) in ascitic fluid and serum. Patients and methods: Fifty cirrhotic patients having ascites with no signs of infection were included. Ascitic fluid cultures were obtained from patients. Ascitic fluid and serum were subjected to DNA extraction and PCR for the universal amplification of a region of the 16S ribosomal RNA (16S rRNA) gene to detect bactDNA. Results: Bacteria were isolated from 9 (18%) of the ascitic fluid samples, and were mainly Gram-positive bacteria. BactDNA was detected simultaneously in the ascitic fluid and serum of 17 (34%) patients and in the ascitic fluid of only 2 patients. In a single patient with positive ascitic fluid culture no bactDNA was detected in ascitic fluid or serum. By considering AFIs as a positive ascitic fluid culture and/or the presence of bactDNA in the ascitic fluid and/or serum, ascitic fluid culture could detect 9 out of 20 patients with AFIs (45%), PCR of ascitic fluid could detect 19 out of 20 (95%) while PCR of serum could detect 17 out of 20 (85%). In 10 patients with culture negative non-neutrocytic ascites (CNNNA) bactDNA could be detected in serum and ascitic fluid. Conclusion: AFI can be caused by Gram positive as well as Gram negative organisms. A substantial percentage of cases with CNNNA show bactDNA in serum and ascitic fluid. PCR of ascitic fluid should, therefore, be used in the diagnostic workup of suspected cases of ascitic fluid infections.
Scholars Journal of Applied Medical Sciences, 2019
Background: Chronic liver disease (CLD) is not uncommon in Bangladesh. Ascites is common feature of CLD patients. Ascites is a culture media for bacterial infection. Spontaneous bacterial peritonitis is a frequent complication of ascites in children with chronic liver disease. The rapid and effective diagnosis of peritonitis will reduce mortality. Aim: The aim of this study is to see the variants of ascitic fluid infection in children with chronic liver disease. Methods: It is a cross sectional observational study. This study was conducted at the department of Pediatric Gastroenterology and Nutrition, BSMMU, Dhaka, Bangladesh without interrupting standard care practiced in the department. The study was done over a period of one & half year, from January 2016 through July 2017. During this period consecutive children CLD with ascites were included in this study. Sample was collected purposively who was fulfilling inclusion criteria. The details history, physical examination findings and investigation reports were recorded in a predesigned standard data sheet. History was obtained directly from the parents, which include jaundice, abdominal pain, fever, diarrhea, family history of liver diseases or other relevant medical histories. Investigations were done for diagnosis of chronic liver disease & identify the cause. Ascitic fluid study especially physical appearance, cytology, total protein, LDH, Gram stain & culture were done in all case. Statistical analysis was done using Statistical Package for Social Science 20.0 (SPSS; Chicago, Illinois) for Windows XP. Results: A total of 30 children were selected according to selection criteria. After ascitic fluid study, all patients were divided into two groups: Group I included five patients (16.67%) with culture negative neutrocytic ascites (CNNA) in which the neutrophil count ≥ 250/mm3 and culture was negative indicate infected group. Group II, twenty five (83.33%) patients in which the neutrophil count < 250/mm3 and negative culture indicate non infected group. None of our patients had spontaneous bacterial peritonitis (SBP) or bacterascites. Presence of fever, history of abdominal pain and tenderness significantly higher in CNNA group (p<0.05). Conclusions: Culture negative neutrocytic ascites (CNNA) was the only variety of ascitic fluid infection in this study. Infected cases may be asymptomatic. Clinical features of ascitic fluid infection are needed to differentiate the infected and non-infected cases. Ascitic fluid study is essential to identify infection. Culture of ascitic fluid is not always diagnostic of infection.
Bacteriologic study of cirrhotic patients with non-neutrocytic ascites
Aim: We aimed for detection of bacterial DNA (bactDNA) in spontaneous bacterial peritonitis (SBP) by polymerase chain reaction (PCR) and its prognostic relevance in cirrhotic patients with culture-negative non-neutrocytic ascites (CNNNA). Background: approximately 60% of patients with spontaneous bacterial peritonitis (SBP) are ascites culture negative. Patients and methods: Of each 77 patients with cirrhosis and ascites, two samples including blood and ascitic fluid (AF) were taken. Blood samples were obtained for routine biochemical study and PMN count. AF samples were used for biochemical analysis and aerobic and anaerobic culture. BactDNA was detected by polymerase chain reaction (PCR) using bacterial universal 16srRNA gene primer. Results: Of all AF samples, 3 (3.9%) were positive for bacterial culture (one streptococcus α hemolytic and two E.coli). The mean number of PMN in AF was 63. BactDNA was detected in 33 (42.9%) of 77 of samples (group A) and bactDNA was absent in 41 (5...
Frequency of spontaneous bacterial peritonitis in liver cirrhosis patients with ascites
International journal of health sciences
Background: When cirrhosis and ascites are present, a very common bacterial infection known as spontaneous bacterial peritonitis (SBP) often develops. This condition must be early diagnosed and treated to reduce morbidity and mortality. Objective: To assess the frequency of Spontaneous Bacterial Peritonitis in Liver Cirrhosis patients with Ascites. Methodology: This cross sectional study was carried out at the department of gastroenterology, Lady Reading Hospital Peshawar. The duration of study was two years from January 2018 to December 2019. Spontaneous bacterial peritonitis was diagnosed as positive when the ascitic fluid bacterial culture was positive. Ascitic fluid was taken in aseptic condition and send to the hospital diagnostic laboratory for the culture test. All the information’s were recorded in a proforma designed for this research. Data was analyzed by using SPSS version 24. Results: In the current research, totally 150 liver cirrhosis patients with ascites were enroll...
The Medical Journal of Cairo University
Background: Liver cirrhosis represents one of the major causes of death worldwide. Many complications can be detected in liver cirrhosis. Among these complications is ascites which seems to be the most frequent one. Patients with cirrhosis and ascites show a higher susceptibility to bacterial infections mainly because of the inadequate defense mechanisms. In those patients, the most frequent infectious complication that occurs and at the same time the most severe one is spontaneous bacterial peritonitis.
PLOS ONE, 2018
Ascitic fluid infection is a major cause of morbidity and mortality in cirrhotic patients, requiring early diagnosis and therapy. We aimed to determine predictors of ascitic fluid infection in children with chronic liver disease. The study included 45 children with chronic liver disease and ascites who underwent 66 paracentesis procedures. Full history taking and clinical examination of all patients were obtained including fever, abdominal pain and tenderness and respiratory distress. Investigations included: complete blood count, C-reactive protein, full liver function tests, ascitic fluid biochemical analysis, cell count and culture. Our results showed that patients' ages ranged between 3 months to 12 years. Prevalence of ascitic fluid infection was 33.3%. Gram-positive bacteria were identified in six cases, and Gramnegative bacteria in five. Fever and abdominal pain were significantly more associated with infected ascites (p value = 0.004, 0.006). Patients with ascitic fluid infection had statistically significant elevated absolute neutrophilic count and C-reactive protein. Logistic regression analysis showed that fever, abdominal pain, elevated absolute neutrophilic count and positive C-reactive protein are independent predictors of ascitic fluid infection. Fever, elevated absolute neutrophilic count and positive C-reactive protein raise the probability of ascitic fluid infection by 3.88, 9.15 and 4.48 times respectively. The cutoff value for C-reactive protein for ascitic fluid infection was 7.2 with sensitivity 73% and specificity of 71%. In conclusion, prevalence of ascitic fluid infection in pediatric patients with chronic liver disease and ascites was 33.3%. Fever, abdominal pain, positive C-reactive protein and elevated absolute neutrophilic count are strong predictors of ascitic fluid infection. Therefore an empirical course of first-line antibiotics should be immediately started with presence of any of these predictors after performing ascitic fluid tapping for culture and sensitivity. In absence of these infection parameters, routine ascitic fluid analysis could be spared.