Spontaneous ascitic fluid infection in liver cirrhosis: bacteriological profile and response to antibiotic therapy

Bhat, Ganesh and Vandana, KE and Bhatia, Sumit and Suvarna, Deepak and Pai, Ganesh C (2013) Spontaneous ascitic fluid infection in liver cirrhosis: bacteriological profile and response to antibiotic therapy. Indian Journal of Gastroenterology, 32 (5). pp. 297-301.

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Background:Spontaneous ascitic fluid infection (SAI) is common in cirrhotic patients leading to significant morbidity and mortality. Third-generation cephalosporins are currently recommended as first-line therapy. We conducted a prospective study to determine bacterial etiology, susceptibility patterns, and clinical epidemiology including 1-month mortality of SAIs among patients with cirrhosis. Methods: Records of 600 patients with suspected SAI over a 4- year period were analyzed. Empirical cefotaxime/ceftriaxone was initiated in patients who had a neutrophil count >250/mm3. Treatment failure was defined by absence of clinical improvement and/or significant decrease in neutrophil count of ascites (<25 % of base line value) by 72 h of therapy. Results: Seventy patients (11.6 %) had SAI, including 40 (57.1 %) culture-negative neutrocytic ascites (CNNA), 25 (35.8 %) spontaneous bacterial peritonitis (SBP), and five (7 %) monomicrobial non-neutrocytic bacterascites (MNB). Gram-negative bacilli (Klebsiella and E. coli) were the commonest organisms. The overall response rate to ceftriaxone was 62.8 % (44/70). Among culture-positive patients (SBP and MNB), sensitivity rates to ceftriaxone was 50 %, while it was 53.3 % for quinolones, 70 % for piperacillin– tazobactam, and 93.3 % for cefoperazone–sulbactam combination. Thirty-day mortality was lower for CNNA compared to SBP (20 % vs. 40 %, p<0.001) and for patients with response compared to no response to first antibiotic (11.3 % vs. 53.8 %, p<0.001). Conclusion: The response of SAI to third-generation cephalosporins was low at our center. Cefoperazone–sulbactam could be a better alternative choice.

Item Type: Article
Uncontrolled Keywords: Antibiotic sensitivity; Ascitic fluid culture; Peritoneal infections.
Subjects: Medicine > KMC Manipal > Gastroenterology
Medicine > KMC Manipal > Microbiology
Depositing User: KMC Manipal
Date Deposited: 02 Sep 2013 04:32
Last Modified: 02 Sep 2013 04:32
URI: http://eprints.manipal.edu/id/eprint/137007

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