Spontaneous bacterial peritonitis (SBP) in patients with cirrhotic liver disease is a serious complication that contributes to the high morbidity and mortality rate seen in this population. Currently, there is a lack ...Spontaneous bacterial peritonitis (SBP) in patients with cirrhotic liver disease is a serious complication that contributes to the high morbidity and mortality rate seen in this population. Currently, there is a lack of consensus amongst the research community on the clinical predictors of SBP as well as the risks and benefits of prophylactic antibiotic therapy in these patients. Pharmacological gastric acid suppression (namely with PPIs and H2RAs) are frequently prescribed for these patients, many times without a clear indication, and may contribute to gut bacterial overflow and SBP development. However, this remains controversial as there are conflicting findings in SBP prevalence between PPI/H2RA-users and non-users. In addition, studies show recent antibiotic use, whether for SBP prophylaxis or for another infectious process, appear to be associated with higher rates of SBP and drug-resistant organisms. Other researchers have also explored the link between zinc, platelet indices (MPV), and macrophage inflammatory protein-1 β (MIP-1β) levels in liver cirrhosis, all of which appear to be promising markers for classifying SBP risk and diagnosis. This literature review was limited by the number and quality of studies available as most are retrospective in nature. Thus, more ongoing, prospective studies and trials are needed to judge the true value of the findings in the studies reviewed in hopes that they can guide appropriate prevention, diagnosis, and management of SBP.展开更多
Spontaneous bacterial peritonitis(SBP)is one of the most common complications in patients with end-stage liver disease(ESLD),which increases the risk of short-term mortality.Proton pump inhibitors(PPIs)are frequently ...Spontaneous bacterial peritonitis(SBP)is one of the most common complications in patients with end-stage liver disease(ESLD),which increases the risk of short-term mortality.Proton pump inhibitors(PPIs)are frequently used in patients with ESLD,in which controversies about the risk of PPI treatment in the occurrence of SBP are largely raised and the pathogenic mechanism of PPI-associated SBP remains unclear.We conducted a systematic literature search through PubMed/MEDLINE for publications mainly from 1 January 2000 to 1 January 2021.Our narrative review summarized the adverse effect of specific PPI therapy on the occurrence and prognosis of SBP in cirrhotic patients,described the potential mechanisms by which PPI induces the development of SBP,and discussed the risk factors associated with the development of SBP and the strategy of PPI therapy in cirrhotic patients.Although controversy regarding the association between PPI use and the occurrence of SBP exists,PPIs use should be restricted to patients with clear benefit indications,and be cautious for elderly patients with severe liver damage.展开更多
Spontaneous bacterial peritonitis (SBP) is a serious complication of liver cirrhosis, with a recurrence rate up to 70% at 1 yr. Diagnosis of SBP is based on a positive ascitic fluid (AF) culture and/or a polymorph nuc...Spontaneous bacterial peritonitis (SBP) is a serious complication of liver cirrhosis, with a recurrence rate up to 70% at 1 yr. Diagnosis of SBP is based on a positive ascitic fluid (AF) culture and/or a polymorph nuclear leukocyte count of >250 cells/μL. Third generation cephalosporins had been viewed as the drug of choice. Aim of the work: to study features, and outcomes of spontaneous bacterial peritonitis in National Liver Institute (Menofia University), a single center study. Methods: This work was conducted on 60 patients had SBP. All patient had AF analysis, bedside AF culture, Blood culture (BC), Serum albumin, Ascitic fluid gradient (SAAG). Results: The more severe the liver disease, as assessed by Child-Turcotte-Pugh (CTP score), the higher the possibility to have positivity of AF culture. Patient who had positive BC had significant rising of Creatinine. The pattern of infection in AF culture is close to that of BC, but Streptococci take the upper hand in BC and Staphylococcus in AF culture. Gram-positive organisms are more common in both AF and BC than gram negative. Mortality rate was higher in culture positive SBP patients 46.2%, and BC positive patients, 62.5%. In all positive cultures patients, Staph Species represents 44.8% with mortality rate of 42% of all mortalities. Most of them were resistant to cephalosporin 62.5%. Strep species represents 31% with mortality rate of 20%. E. coli represents 24.2% with mortality rate of 20%. Conclusion: The microbial pattern of organisms responsible for SBP has changed with predominance of gram-positive organisms. Pattern of microbial infection is similar in both blood and ascetic fluid culture, so BC results can be relied upon to guide therapy, in negative AF culture.展开更多
BACKGROUND Proton pump inhibitors(PPIs)are widely prescribed,often without clear indications.There are conflicting data on its association with mortality risk and hepatic decompensation in cirrhotic patients.Furthermo...BACKGROUND Proton pump inhibitors(PPIs)are widely prescribed,often without clear indications.There are conflicting data on its association with mortality risk and hepatic decompensation in cirrhotic patients.Furthermore,PPI users and PPI exposure in some studies have been poorly defined with many confounding factors.AIM To examine if PPI use increases mortality and hepatic decompensation and the impact of cumulative PPI dose exposure.METHODS Data from patients with decompensated liver cirrhosis were extracted from a hospital database between 2013 to 2017.PPI users were defined as cumulative defined daily dose(cDDD)≥28 within a landmark period,after hospitalisation for hepatic decompensation.Cox regression analysis for comparison was done after propensity score adjustment.Further risk of hepatic decompensation was analysed by Poisson regression.RESULTS Among 295 decompensated cirrhosis patients,238 were PPI users and 57 were non-users.PPI users had higher mortality compared to non-users[adjusted HR=2.10,(1.20-3.67);P=0.009].Longer PPI use with cDDD>90 was associated with higher mortality,compared to non-users[aHR=2.27,(1.10-5.14);P=0.038].PPI users had a higher incidence of hospitalization for hepatic decompensation[aRR=1.61,(1.30-2.11);P<0.001].CONCLUSION PPI use in decompensated cirrhosis is associated with increased risk of mortality and hepatic decompensation.Longer PPI exposure with cDDD>90 increases the risk of mortality.展开更多
文摘Spontaneous bacterial peritonitis (SBP) in patients with cirrhotic liver disease is a serious complication that contributes to the high morbidity and mortality rate seen in this population. Currently, there is a lack of consensus amongst the research community on the clinical predictors of SBP as well as the risks and benefits of prophylactic antibiotic therapy in these patients. Pharmacological gastric acid suppression (namely with PPIs and H2RAs) are frequently prescribed for these patients, many times without a clear indication, and may contribute to gut bacterial overflow and SBP development. However, this remains controversial as there are conflicting findings in SBP prevalence between PPI/H2RA-users and non-users. In addition, studies show recent antibiotic use, whether for SBP prophylaxis or for another infectious process, appear to be associated with higher rates of SBP and drug-resistant organisms. Other researchers have also explored the link between zinc, platelet indices (MPV), and macrophage inflammatory protein-1 β (MIP-1β) levels in liver cirrhosis, all of which appear to be promising markers for classifying SBP risk and diagnosis. This literature review was limited by the number and quality of studies available as most are retrospective in nature. Thus, more ongoing, prospective studies and trials are needed to judge the true value of the findings in the studies reviewed in hopes that they can guide appropriate prevention, diagnosis, and management of SBP.
文摘Spontaneous bacterial peritonitis(SBP)is one of the most common complications in patients with end-stage liver disease(ESLD),which increases the risk of short-term mortality.Proton pump inhibitors(PPIs)are frequently used in patients with ESLD,in which controversies about the risk of PPI treatment in the occurrence of SBP are largely raised and the pathogenic mechanism of PPI-associated SBP remains unclear.We conducted a systematic literature search through PubMed/MEDLINE for publications mainly from 1 January 2000 to 1 January 2021.Our narrative review summarized the adverse effect of specific PPI therapy on the occurrence and prognosis of SBP in cirrhotic patients,described the potential mechanisms by which PPI induces the development of SBP,and discussed the risk factors associated with the development of SBP and the strategy of PPI therapy in cirrhotic patients.Although controversy regarding the association between PPI use and the occurrence of SBP exists,PPIs use should be restricted to patients with clear benefit indications,and be cautious for elderly patients with severe liver damage.
文摘Spontaneous bacterial peritonitis (SBP) is a serious complication of liver cirrhosis, with a recurrence rate up to 70% at 1 yr. Diagnosis of SBP is based on a positive ascitic fluid (AF) culture and/or a polymorph nuclear leukocyte count of >250 cells/μL. Third generation cephalosporins had been viewed as the drug of choice. Aim of the work: to study features, and outcomes of spontaneous bacterial peritonitis in National Liver Institute (Menofia University), a single center study. Methods: This work was conducted on 60 patients had SBP. All patient had AF analysis, bedside AF culture, Blood culture (BC), Serum albumin, Ascitic fluid gradient (SAAG). Results: The more severe the liver disease, as assessed by Child-Turcotte-Pugh (CTP score), the higher the possibility to have positivity of AF culture. Patient who had positive BC had significant rising of Creatinine. The pattern of infection in AF culture is close to that of BC, but Streptococci take the upper hand in BC and Staphylococcus in AF culture. Gram-positive organisms are more common in both AF and BC than gram negative. Mortality rate was higher in culture positive SBP patients 46.2%, and BC positive patients, 62.5%. In all positive cultures patients, Staph Species represents 44.8% with mortality rate of 42% of all mortalities. Most of them were resistant to cephalosporin 62.5%. Strep species represents 31% with mortality rate of 20%. E. coli represents 24.2% with mortality rate of 20%. Conclusion: The microbial pattern of organisms responsible for SBP has changed with predominance of gram-positive organisms. Pattern of microbial infection is similar in both blood and ascetic fluid culture, so BC results can be relied upon to guide therapy, in negative AF culture.
文摘BACKGROUND Proton pump inhibitors(PPIs)are widely prescribed,often without clear indications.There are conflicting data on its association with mortality risk and hepatic decompensation in cirrhotic patients.Furthermore,PPI users and PPI exposure in some studies have been poorly defined with many confounding factors.AIM To examine if PPI use increases mortality and hepatic decompensation and the impact of cumulative PPI dose exposure.METHODS Data from patients with decompensated liver cirrhosis were extracted from a hospital database between 2013 to 2017.PPI users were defined as cumulative defined daily dose(cDDD)≥28 within a landmark period,after hospitalisation for hepatic decompensation.Cox regression analysis for comparison was done after propensity score adjustment.Further risk of hepatic decompensation was analysed by Poisson regression.RESULTS Among 295 decompensated cirrhosis patients,238 were PPI users and 57 were non-users.PPI users had higher mortality compared to non-users[adjusted HR=2.10,(1.20-3.67);P=0.009].Longer PPI use with cDDD>90 was associated with higher mortality,compared to non-users[aHR=2.27,(1.10-5.14);P=0.038].PPI users had a higher incidence of hospitalization for hepatic decompensation[aRR=1.61,(1.30-2.11);P<0.001].CONCLUSION PPI use in decompensated cirrhosis is associated with increased risk of mortality and hepatic decompensation.Longer PPI exposure with cDDD>90 increases the risk of mortality.
