Ascites remain the commonest complication of decompensated cirrhosis. Spontaneous bacterial peritonitis (SBP) is defined as the infection of ascitic fluid (AF) in the absence of a contiguous source of infection and/or...Ascites remain the commonest complication of decompensated cirrhosis. Spontaneous bacterial peritonitis (SBP) is defined as the infection of ascitic fluid (AF) in the absence of a contiguous source of infection and/or an intraabdominal inflammatory focus. An AF polymorphonuclear (PMN) leucocyte count ≥ 250/mm 3 -irrespective of the AF culture resultis universally accepted nowadays as the best surrogate marker for diagnosing SBP. Frequently the results of the manual or automated PMN count do not reach the hands of the responsible medical personnel in a timely manner. However, this is a crucial step in SBP management. Since 2000, 26 studies (most of them published as full papers) have checked the validity of using leukocyte esterase reagent strips (LERS) in SBP diagnosis. LERS appear to have low sensitivity for SBP, some LERS types more than others. On the other hand, though, LERS have consistently given a high negative predictive value (> 95% in the majority of the studies) and this supports the use of LERS as a preliminary screening tool for SBP diagnosis. Finally, an AF-tailored dipstick has been developed. Within the proper setting, it is set to become the mainstream process for handling AF samples.展开更多
Polymorphonuclear (PMN) cell count in the ascitic fluid is essential for the diagnosis and management of spontaneous bacterial peritonitis (SBP). To date, PMN cell count is routinely performed by traditional manual co...Polymorphonuclear (PMN) cell count in the ascitic fluid is essential for the diagnosis and management of spontaneous bacterial peritonitis (SBP). To date, PMN cell count is routinely performed by traditional manual counting. However, this method is time-consuming, costly, and not always timely available. Therefore, considerable efforts have been made in recent years to develop an alternative test for a more rapid diagnosis and monitoring of SBP. The use of urinary reagent strips was proposed to achieve an "instant" bedside diagnosis of SBP. A series of reports evaluated the urine strip test for SBP diagnosis and reported promising results. However, a recent large multicenter study revealed a surprising lack of diagnostic effi cacy of the urine screening test for SBP diagnosis. Another method, more recently proposed as an alternative to the manual PMN count, is the measurement of lactoferrin in ascitic fluid, but the data available on the diagnostic value of this test are limited to a single study. However, both urinary reagent strips and ascitic lactoferrin tests are qualitative methods and need, therefore, to be further confirmed by standard cytology of the ascitic fluid. To date, the only quantitative method proposed as a valid alternative to manual PMN counting is automated blood cell counters, commonly used in all laboratories for blood cell counting. Data available in the literature on the diagnostic performance of this method are limited but very promising, and this tool seems to have the potential to replace the manual counting method.展开更多
Since its initial description in 1964,research hastransformed spontaneous bacterial peritonitis (SBP)from a feared disease (with reported mortality of 90%)to a treatable complication of decompensated cirrhosis,albeit ...Since its initial description in 1964,research hastransformed spontaneous bacterial peritonitis (SBP)from a feared disease (with reported mortality of 90%)to a treatable complication of decompensated cirrhosis,albeit with steady prevalence and a high recurrencerate. Bacterial translocation,the key mechanism in thepathogenesis of SBP,is only possible because of theconcurrent failure of defensive mechanisms in cirrhosis.Variants of SBP should be treated. Leucocyte esterasereagent strips have managed to shorten the 'tap-to-shot' time,while future studies should look into theircombined use with ascitic fluid pH. Third generationcephalosporins are the antibiotic of choice becausethey have a number of advantages. Renal dysfunctionhas been shown to be an independent predictor ofmortality in patients with SBP. Albumin is felt to reducethe risk of renal impairment by improving effectiveintravascular volume,and by helping to bind pro-inflammatory molecules. Following a single episodeof SBP,patients should have long-term antibioticprophylaxis and be considered for liver transplantation.展开更多
文摘Ascites remain the commonest complication of decompensated cirrhosis. Spontaneous bacterial peritonitis (SBP) is defined as the infection of ascitic fluid (AF) in the absence of a contiguous source of infection and/or an intraabdominal inflammatory focus. An AF polymorphonuclear (PMN) leucocyte count ≥ 250/mm 3 -irrespective of the AF culture resultis universally accepted nowadays as the best surrogate marker for diagnosing SBP. Frequently the results of the manual or automated PMN count do not reach the hands of the responsible medical personnel in a timely manner. However, this is a crucial step in SBP management. Since 2000, 26 studies (most of them published as full papers) have checked the validity of using leukocyte esterase reagent strips (LERS) in SBP diagnosis. LERS appear to have low sensitivity for SBP, some LERS types more than others. On the other hand, though, LERS have consistently given a high negative predictive value (> 95% in the majority of the studies) and this supports the use of LERS as a preliminary screening tool for SBP diagnosis. Finally, an AF-tailored dipstick has been developed. Within the proper setting, it is set to become the mainstream process for handling AF samples.
文摘Polymorphonuclear (PMN) cell count in the ascitic fluid is essential for the diagnosis and management of spontaneous bacterial peritonitis (SBP). To date, PMN cell count is routinely performed by traditional manual counting. However, this method is time-consuming, costly, and not always timely available. Therefore, considerable efforts have been made in recent years to develop an alternative test for a more rapid diagnosis and monitoring of SBP. The use of urinary reagent strips was proposed to achieve an "instant" bedside diagnosis of SBP. A series of reports evaluated the urine strip test for SBP diagnosis and reported promising results. However, a recent large multicenter study revealed a surprising lack of diagnostic effi cacy of the urine screening test for SBP diagnosis. Another method, more recently proposed as an alternative to the manual PMN count, is the measurement of lactoferrin in ascitic fluid, but the data available on the diagnostic value of this test are limited to a single study. However, both urinary reagent strips and ascitic lactoferrin tests are qualitative methods and need, therefore, to be further confirmed by standard cytology of the ascitic fluid. To date, the only quantitative method proposed as a valid alternative to manual PMN counting is automated blood cell counters, commonly used in all laboratories for blood cell counting. Data available in the literature on the diagnostic performance of this method are limited but very promising, and this tool seems to have the potential to replace the manual counting method.
文摘Since its initial description in 1964,research hastransformed spontaneous bacterial peritonitis (SBP)from a feared disease (with reported mortality of 90%)to a treatable complication of decompensated cirrhosis,albeit with steady prevalence and a high recurrencerate. Bacterial translocation,the key mechanism in thepathogenesis of SBP,is only possible because of theconcurrent failure of defensive mechanisms in cirrhosis.Variants of SBP should be treated. Leucocyte esterasereagent strips have managed to shorten the 'tap-to-shot' time,while future studies should look into theircombined use with ascitic fluid pH. Third generationcephalosporins are the antibiotic of choice becausethey have a number of advantages. Renal dysfunctionhas been shown to be an independent predictor ofmortality in patients with SBP. Albumin is felt to reducethe risk of renal impairment by improving effectiveintravascular volume,and by helping to bind pro-inflammatory molecules. Following a single episodeof SBP,patients should have long-term antibioticprophylaxis and be considered for liver transplantation.
