Clinical Features of Spontaneous Bacterial Peritonitis: A 10-year Experience from a Single Center

Ha Young Na; Jeong Han Kim; Won Hyeok Choe; So Young Kwon; Byung-chul Yoo

doi:10.4166/kjg.2017.69.2.129

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Na, Kim, Choe, Kwon, and Yoo: Clinical Features of Spontaneous Bacterial Peritonitis: A 10-year Experience from a Single Center

Original Article

Korean J Gastroenterol 2017;69(2):129-134.

Published online: 4 October 2017

DOI: https://doi.org/10.4166/kjg.2017.69.2.129

Clinical Features of Spontaneous Bacterial Peritonitis: A 10-year Experience from a Single Center

Ha Young Na, Jeong Han Kim, Won Hyeok Choe, So Young Kwon, Byung-chul Yoo

Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea

Correspondence to: Jeong Han Kim, Department of Internal Medicine, Konkuk University School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 05030, Korea. Tel: +82-2-2030-7764, Fax: +82-2-2030-5029, E-mail: 93haan@hanmail.net

Received 22 June 2016 Revised 24 November 2016 Accepted 25 November 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Spontaneous bacterial peritonitis (SBP) is one of critical complications in liver cirrhosis patients with ascites. We aimed to review clinical course of SBP patients in a 10-year period from single center.

Methods

This study enrolled SBP patients between 2005 and 2015. Their medical records were reviewed. The laboratory findings of serum and ascites were examined, and characteristics of isolated microorganisms in ascites were analyzed.

Results

Total 51 patients were enrolled. Male patients were predominant (64.7%), and mean age was 59.20 years. The most common etiology of cirrhosis was alcohol (41.2%), followed by hepatitis B (39.2%). Microorganism was isolated from the ascites in 31 patients (60.78%). The proportions of Gram negative and Gram positive were 80.64% and 19.36%. The proportions of Escherichia coli, Klebsiella, and Streptococcus species were 29.41%, 19.61% and 11.76%. Among Escherichia colis, 4 cases were ESBL positive (7.84%). The most commonly used first-line antibiotic was cefotaxime (80.40%). Prophylactic antibiotics treatment was performed only in 8 patients, and SBP was recurred in 7 patients (13.72%). When comparing the SBP recurrence group and the non-recurrence group, there were no significant differences in laboratory findings of serum and ascitic fluid.

Conclusions

SBP is still a critical complication in cirrhosis patients with ascites, and the clinical features of SBP have not been altered much compared with those in 1990's. The effective treatment of SBP is still very important for a better prognosis of cirrhosis patients.

References

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Fig. 1.

Study flowchart, 2005–2015. KUH, Konkuk University Hospital.

Table 1.

Baseline Characteristics of the Enrolled Patients (n=51)

Variable	Value
Gender
Male	33 (64.7)
Female	18 (35.3)
Age (yr, mean±SD) ^a	59.2 (32–87)
Cause
HBV	20 (39.22)
HCV	3 (5.88)
Alcohol	21 (41.18)
Cryptogenic	7 (13.72)
Death	22 (43.13)
Cause of death
Septic shock d/t SBP aggravation	17 (77.27)
HEP	2 (9.08)
HRS	1 (4.55)
Septic shock d/t pancreatitis	1 (4.55)
Aspiration pneumonia	1 (4.55)
Child-Pugh class
A	0 (0)
B	6 (11.80)
C	45 (88.20)
MELD score
<20	12 (23.53)
≥20	39 (76.47)
Laboratory findings ^a	Median (range)
Serum
Albumin (g/dL)	2.36 (1.60–3.60)
Bilirubin (mg/dL)	10.45 (0.90–32.40)
PLT (x10³/μ L)	93.97 (13–362)
Prothrombin time (INR)	2.26 (1.15–6.70)
Creatinine (mg/dL)	1.71 (0.50–4.60)
Ascitic fluid
PMN (cells/mm³)	6241.77 (235.51–31684.02
Protein (g/dL)	1.13 (0.41–3.21)
LDH (IU/L)	372.12 (40.76–5987.05)
Glucose (mg/dL)	132.64 (13.70–245.85)

Values are presented as number (%).

SD, standard deviation; HBV, hepatitis B virus; HCV, hepatitis C virus HRS, hepatorenal syndrome; HEP, hepatic encephalopathy; MELD, mode for end-stage liver disease; PLT, platelet; PMN, polymorphonuclea leukocyte; LDH, lactate dehydrogenase.

^a Expressed as median (range).

Table 2.

Cultured Bacteria and Antibiotics

Variable	Value
Cultured bacteria
Gram negative	25 (49.02)
ESBL (−) Escherichia coli	11 (21.57)
ESBL (+) Escherichia coli	4 (7.84)
Klebsiella species	10 (19.61)
Gram positive
Streptococcus species	6 (11.76)
None	20 (39.22)
Antibiotics
Cefotaxime	41 (80.40)
Ceftriaxone	5 (9.80)
Ciprofloxacin	5 (9.80)

Values are presented as number (%).

Table 3.

SBP Recurrence Group vs. Non-recurrence Group

	Recurrence group (n=7)	Non-recurrence group (n=44)	p-value
Age (yr, mean±SD)	57.71±13.74	57.23±12.94	0.92
Duration	9.00±3.83	10.91±7.33	0.77
Asc-PMN (cells/mm³)	6347.76±6238.43	6248.28±8506.01	0.97
Asc-protein (g/dL)	1.50±0.78	1.08±0.61	0.12
Asc-LDH (IU/L)	180.14±118.41	431.64±1000.43	0.51
Alb (g/dL)	2.50±0.42	2.32±0.41	0.31
Tbil (mg/dL)	9.25±8.21	10.33±8.39	0.75
Cr (mg/dL)	1.79±0.80	1.78±1.01	0.97
PT	1.94±0.61	2.30±1.19	0.44
CPscore	11.43±2.14	11.48±1.62	0.94
MELD	25.32±7.35	26.31±9.94	0.80

Values are presented as mean±standard deviation.

SBP, spontaneous bacterial peritonitis; SD, standard deviation; Duration; antibiotics treatment period; Asc, ascites; PMN, polymorphonuclear leukocyte; LDH, lactate dehydrogenase; Alb, albumin; Tbil, total bilirubin; Cr, creatinin; PT, prothrombin time; CPscore, Child-Pugh score; MELD, model for end-stage liver disease.

Table 4.

SBP Recurrence Group vs. Non-recurrence Group

		Recurrence	Non-recurrence	p-value
Sex	Male/Female	2/5	28/16	1.0
Etiology	HBV	2	18	0.41
	HCV	1	2
	Alcohol	4	17
	Cryptogenic	0	7
HRS	Yes/No	0/7	10/34	0.67
Bacteria	Gram negative			0.42
	− ESBL (−) E.coli	1	10
	− Klebsiella species	0	10
	− ESBL (+) E.coli	1	3
	Gram positive	0	6
	None	5	15
Antibiotics	Cefotaxime/Others	4/3	37/7	0.14
SecondAbs	Yes/No	1/6	6/38	1.0
Prophylaxis	Yes/No	1/6	7/37	1.0

SBP, spontaneous bacterial peritonitis; HRS, hepatorenal syndrome; SecondAbs, secondary antibiotics; ESBL, Extended-spectrum beta-lactamase; E.coli, Escherichia coli.

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