Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies

Sebastián Marciano,1,2 Juan Manuel Díaz,1 Melisa Dirchwolf,3 Adrián Gadano1,2 1Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 2Department of Research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 3Hepatology Unit, Hospital Priv...

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Autores principales: Marciano S, Diaz JM, Dirchwolf M, Gadano A
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Publicado: Dove Medical Press 2019
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spelling oai:doaj.org-article:ed418269c48f4b65a72e11b13aa653b02021-12-02T00:24:26ZSpontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies1179-1535https://doaj.org/article/ed418269c48f4b65a72e11b13aa653b02019-01-01T00:00:00Zhttps://www.dovepress.com/spontaneous-bacterial-peritonitis-in-patients-with-cirrhosis-incidence-peer-reviewed-article-HMERhttps://doaj.org/toc/1179-1535Sebastián Marciano,1,2 Juan Manuel Díaz,1 Melisa Dirchwolf,3 Adrián Gadano1,2 1Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 2Department of Research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 3Hepatology Unit, Hospital Privado de Rosario, Santa Fe, Argentina Abstract: Spontaneous bacterial peritonitis is the most frequent bacterial infection in patients with cirrhosis. The reported incidence varies between 7% and 30% in hospitalized patients with cirrhosis and ascites, representing one of their main complications. Outcomes in patients with spontaneous bacterial peritonitis are poor since acute kidney injury, acute-on-chronic liver failure, and death occur in as much as 54%, 60%, and 40% of the patients, respectively, at midterm. Early antibiotic treatment of spontaneous bacterial peritonitis is crucial. However, the landscape of microbiological resistance is continuously changing, with an increasing spread of multidrug-resistant organisms that make its current management more challenging. Thus, the selection of the empirical antibiotic treatment should be guided by the severity and location where the infection was acquired, the risk factors for multidrug-resistant organisms, and the available information on the local expected bacteriology. The use of albumin as a complementary therapy for selected high-risk patients with spontaneous bacterial peritonitis is recommended in addition to antibiotics. Even though antibiotic prophylaxis has proven to be effective to prevent spontaneous bacterial peritonitis, a careful selection of high-risk candidates is crucial to avoid antibiotic overuse. In this article we review the pathogenesis, risk factors, and prognosis of spontaneous bacterial peritonitis, as well as the current evidence regarding its treatment and prophylaxis. Keywords: bacterial infections, acute-on-chronic liver failure, drug resistance, antibiotic prophylaxis, acute kidney injuryMarciano SDiaz JMDirchwolf MGadano ADove Medical PressarticleBacterial InfectionsAcute-On-Chronic Liver FailureDrug ResistanceAntibiotic ProphylaxisAcute Kidney Injury.Diseases of the digestive system. GastroenterologyRC799-869ENHepatic Medicine: Evidence and Research, Vol Volume 11, Pp 13-22 (2019)
institution DOAJ
collection DOAJ
language EN
topic Bacterial Infections
Acute-On-Chronic Liver Failure
Drug Resistance
Antibiotic Prophylaxis
Acute Kidney Injury.
Diseases of the digestive system. Gastroenterology
RC799-869
spellingShingle Bacterial Infections
Acute-On-Chronic Liver Failure
Drug Resistance
Antibiotic Prophylaxis
Acute Kidney Injury.
Diseases of the digestive system. Gastroenterology
RC799-869
Marciano S
Diaz JM
Dirchwolf M
Gadano A
Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies
description Sebastián Marciano,1,2 Juan Manuel Díaz,1 Melisa Dirchwolf,3 Adrián Gadano1,2 1Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 2Department of Research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 3Hepatology Unit, Hospital Privado de Rosario, Santa Fe, Argentina Abstract: Spontaneous bacterial peritonitis is the most frequent bacterial infection in patients with cirrhosis. The reported incidence varies between 7% and 30% in hospitalized patients with cirrhosis and ascites, representing one of their main complications. Outcomes in patients with spontaneous bacterial peritonitis are poor since acute kidney injury, acute-on-chronic liver failure, and death occur in as much as 54%, 60%, and 40% of the patients, respectively, at midterm. Early antibiotic treatment of spontaneous bacterial peritonitis is crucial. However, the landscape of microbiological resistance is continuously changing, with an increasing spread of multidrug-resistant organisms that make its current management more challenging. Thus, the selection of the empirical antibiotic treatment should be guided by the severity and location where the infection was acquired, the risk factors for multidrug-resistant organisms, and the available information on the local expected bacteriology. The use of albumin as a complementary therapy for selected high-risk patients with spontaneous bacterial peritonitis is recommended in addition to antibiotics. Even though antibiotic prophylaxis has proven to be effective to prevent spontaneous bacterial peritonitis, a careful selection of high-risk candidates is crucial to avoid antibiotic overuse. In this article we review the pathogenesis, risk factors, and prognosis of spontaneous bacterial peritonitis, as well as the current evidence regarding its treatment and prophylaxis. Keywords: bacterial infections, acute-on-chronic liver failure, drug resistance, antibiotic prophylaxis, acute kidney injury
format article
author Marciano S
Diaz JM
Dirchwolf M
Gadano A
author_facet Marciano S
Diaz JM
Dirchwolf M
Gadano A
author_sort Marciano S
title Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies
title_short Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies
title_full Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies
title_fullStr Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies
title_full_unstemmed Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies
title_sort spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies
publisher Dove Medical Press
publishDate 2019
url https://doaj.org/article/ed418269c48f4b65a72e11b13aa653b0
work_keys_str_mv AT marcianos spontaneousbacterialperitonitisinpatientswithcirrhosisincidenceoutcomesandtreatmentstrategies
AT diazjm spontaneousbacterialperitonitisinpatientswithcirrhosisincidenceoutcomesandtreatmentstrategies
AT dirchwolfm spontaneousbacterialperitonitisinpatientswithcirrhosisincidenceoutcomesandtreatmentstrategies
AT gadanoa spontaneousbacterialperitonitisinpatientswithcirrhosisincidenceoutcomesandtreatmentstrategies
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