Clinical and microbiological characteristics associated with mortality in spontaneous bacterial peritonitis: a multicenter cohort study

OBJECTIVESSpontaneous bacterial peritonitis (SBP) is a prevalent and high mortality complication of cirrhosis. We aimed to describe these patients’ clinical and microbiological characteristics and evaluate their impact on outcomes. METHODSThis was a retrospective cohort study including 139 consecuti...

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Veröffentlicht in:European journal of gastroenterology & hepatology 2016-10, Vol.28 (10), p.1216-1222
Hauptverfasser: Oliveira, Ana M, Branco, Joana C, Barosa, Rita, Rodrigues, José A, Ramos, Lídia, Martins, Alexandra, Karvellas, Constantine J, Cardoso, Filipe S
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container_end_page 1222
container_issue 10
container_start_page 1216
container_title European journal of gastroenterology & hepatology
container_volume 28
creator Oliveira, Ana M
Branco, Joana C
Barosa, Rita
Rodrigues, José A
Ramos, Lídia
Martins, Alexandra
Karvellas, Constantine J
Cardoso, Filipe S
description OBJECTIVESSpontaneous bacterial peritonitis (SBP) is a prevalent and high mortality complication of cirrhosis. We aimed to describe these patients’ clinical and microbiological characteristics and evaluate their impact on outcomes. METHODSThis was a retrospective cohort study including 139 consecutive patients with positive culture SBP from three Portuguese centers diagnosed between 2009 and 2014. Multivariate logistic regression was used to study associations with 30-day mortality. RESULTSThe mean age of the patients was 62 years and 81% of patients were men. The mean model for end-stage liver disease score was 19. Hepatic encephalopathy, hepatorenal syndrome, and variceal bleeding developed in 47, 30, and 21% of patients, respectively. Gram-positive bacteria were isolated in the ascitic fluid of 42% of patients. Resistance to quinolones and multiresistance were found in 33 and 17% of patients, respectively. C-reactive protein level (adjusted odds ratio, 1.16 per 1 mg/l increment) and development of hepatorenal syndrome (adjusted odds ratio, 2.86) were associated independently with 30-day mortality (model’s area under the curve, 0.78). CONCLUSIONIn this cohort, SBP portended high early mortality. Gram-positive bacteria, bacteria resistant to quinolones, and multiresistant bacteria were identified in considerable proportions of patients. In the setting of the high early mortality and changing microbiological profile, SBP management strategies need to be improved.
doi_str_mv 10.1097/MEG.0000000000000700
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We aimed to describe these patients’ clinical and microbiological characteristics and evaluate their impact on outcomes. METHODSThis was a retrospective cohort study including 139 consecutive patients with positive culture SBP from three Portuguese centers diagnosed between 2009 and 2014. Multivariate logistic regression was used to study associations with 30-day mortality. RESULTSThe mean age of the patients was 62 years and 81% of patients were men. The mean model for end-stage liver disease score was 19. Hepatic encephalopathy, hepatorenal syndrome, and variceal bleeding developed in 47, 30, and 21% of patients, respectively. Gram-positive bacteria were isolated in the ascitic fluid of 42% of patients. Resistance to quinolones and multiresistance were found in 33 and 17% of patients, respectively. C-reactive protein level (adjusted odds ratio, 1.16 per 1 mg/l increment) and development of hepatorenal syndrome (adjusted odds ratio, 2.86) were associated independently with 30-day mortality (model’s area under the curve, 0.78). CONCLUSIONIn this cohort, SBP portended high early mortality. Gram-positive bacteria, bacteria resistant to quinolones, and multiresistant bacteria were identified in considerable proportions of patients. In the setting of the high early mortality and changing microbiological profile, SBP management strategies need to be improved.</description><identifier>ISSN: 0954-691X</identifier><identifier>EISSN: 1473-5687</identifier><identifier>DOI: 10.1097/MEG.0000000000000700</identifier><identifier>PMID: 27391170</identifier><language>eng</language><publisher>England: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Aged ; Anti-Bacterial Agents - therapeutic use ; Bacterial Infections - diagnosis ; Bacterial Infections - drug therapy ; Bacterial Infections - microbiology ; Bacterial Infections - mortality ; Chi-Square Distribution ; Drug Resistance, Multiple, Bacterial ; Female ; Humans ; Length of Stay ; Liver Cirrhosis - diagnosis ; Liver Cirrhosis - microbiology ; Liver Cirrhosis - mortality ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Peritonitis - diagnosis ; Peritonitis - drug therapy ; Peritonitis - microbiology ; Peritonitis - mortality ; Portugal - epidemiology ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome</subject><ispartof>European journal of gastroenterology &amp; hepatology, 2016-10, Vol.28 (10), p.1216-1222</ispartof><rights>Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3840-5e67aa6c83c0684f2f28785244315db0ab01792dbe26324dd799e97875538b173</citedby><cites>FETCH-LOGICAL-c3840-5e67aa6c83c0684f2f28785244315db0ab01792dbe26324dd799e97875538b173</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27391170$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Oliveira, Ana M</creatorcontrib><creatorcontrib>Branco, Joana C</creatorcontrib><creatorcontrib>Barosa, Rita</creatorcontrib><creatorcontrib>Rodrigues, José A</creatorcontrib><creatorcontrib>Ramos, Lídia</creatorcontrib><creatorcontrib>Martins, Alexandra</creatorcontrib><creatorcontrib>Karvellas, Constantine J</creatorcontrib><creatorcontrib>Cardoso, Filipe S</creatorcontrib><title>Clinical and microbiological characteristics associated with mortality in spontaneous bacterial peritonitis: a multicenter cohort study</title><title>European journal of gastroenterology &amp; hepatology</title><addtitle>Eur J Gastroenterol Hepatol</addtitle><description>OBJECTIVESSpontaneous bacterial peritonitis (SBP) is a prevalent and high mortality complication of cirrhosis. We aimed to describe these patients’ clinical and microbiological characteristics and evaluate their impact on outcomes. METHODSThis was a retrospective cohort study including 139 consecutive patients with positive culture SBP from three Portuguese centers diagnosed between 2009 and 2014. Multivariate logistic regression was used to study associations with 30-day mortality. RESULTSThe mean age of the patients was 62 years and 81% of patients were men. The mean model for end-stage liver disease score was 19. Hepatic encephalopathy, hepatorenal syndrome, and variceal bleeding developed in 47, 30, and 21% of patients, respectively. Gram-positive bacteria were isolated in the ascitic fluid of 42% of patients. Resistance to quinolones and multiresistance were found in 33 and 17% of patients, respectively. C-reactive protein level (adjusted odds ratio, 1.16 per 1 mg/l increment) and development of hepatorenal syndrome (adjusted odds ratio, 2.86) were associated independently with 30-day mortality (model’s area under the curve, 0.78). CONCLUSIONIn this cohort, SBP portended high early mortality. Gram-positive bacteria, bacteria resistant to quinolones, and multiresistant bacteria were identified in considerable proportions of patients. In the setting of the high early mortality and changing microbiological profile, SBP management strategies need to be improved.</description><subject>Aged</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Bacterial Infections - diagnosis</subject><subject>Bacterial Infections - drug therapy</subject><subject>Bacterial Infections - microbiology</subject><subject>Bacterial Infections - mortality</subject><subject>Chi-Square Distribution</subject><subject>Drug Resistance, Multiple, Bacterial</subject><subject>Female</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Liver Cirrhosis - diagnosis</subject><subject>Liver Cirrhosis - microbiology</subject><subject>Liver Cirrhosis - mortality</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Odds Ratio</subject><subject>Peritonitis - diagnosis</subject><subject>Peritonitis - drug therapy</subject><subject>Peritonitis - microbiology</subject><subject>Peritonitis - mortality</subject><subject>Portugal - epidemiology</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0954-691X</issn><issn>1473-5687</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UU1P3TAQtBBVeYX-gwr5yCXUjh1_cKuegFai4lIkbpbjOMTFiVPb0dP7Bfztmgaqqgf2stJ6ZtY7A8AnjM4xkvzz98vrc_RvcYQOwAZTTqqGCX4INkg2tGIS3x-BDyn9RAhzgvl7cFRzIjHmaAOett5NzmgP9dTB0ZkYWhd8ePgzM4OO2mQbXcrOJKhTCsbpbDu4c3mAY4hZe5f30E0wzWHKerJhSbBdWUViLi2HyWWXLqCG4-KLkp3KKzRhKHyY8tLtT8C7XvtkP770Y3B3dflj-7W6ub3-tv1yUxkiKKoay7jWzAhiEBO0r_tacNHUlBLcdC3SbblR1l1ra0Zq2nVcSiu54E1DRFvOPwZnq-4cw6_FpqxGl4z1fv24wgIzRiiTtEDpCi2epBRtr-boRh33CiP1HIEqEaj_Iyi005cNSzva7i_p1fMCECtgF3yxIT36ZWejGqz2eXhb-zdAyZVZ</recordid><startdate>201610</startdate><enddate>201610</enddate><creator>Oliveira, Ana M</creator><creator>Branco, Joana C</creator><creator>Barosa, Rita</creator><creator>Rodrigues, José A</creator><creator>Ramos, Lídia</creator><creator>Martins, Alexandra</creator><creator>Karvellas, Constantine J</creator><creator>Cardoso, Filipe S</creator><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201610</creationdate><title>Clinical and microbiological characteristics associated with mortality in spontaneous bacterial peritonitis: a multicenter cohort study</title><author>Oliveira, Ana M ; Branco, Joana C ; Barosa, Rita ; Rodrigues, José A ; Ramos, Lídia ; Martins, Alexandra ; Karvellas, Constantine J ; Cardoso, Filipe S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3840-5e67aa6c83c0684f2f28785244315db0ab01792dbe26324dd799e97875538b173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Bacterial Infections - diagnosis</topic><topic>Bacterial Infections - drug therapy</topic><topic>Bacterial Infections - microbiology</topic><topic>Bacterial Infections - mortality</topic><topic>Chi-Square Distribution</topic><topic>Drug Resistance, Multiple, Bacterial</topic><topic>Female</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Liver Cirrhosis - diagnosis</topic><topic>Liver Cirrhosis - microbiology</topic><topic>Liver Cirrhosis - mortality</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Odds Ratio</topic><topic>Peritonitis - diagnosis</topic><topic>Peritonitis - drug therapy</topic><topic>Peritonitis - microbiology</topic><topic>Peritonitis - mortality</topic><topic>Portugal - epidemiology</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Oliveira, Ana M</creatorcontrib><creatorcontrib>Branco, Joana C</creatorcontrib><creatorcontrib>Barosa, Rita</creatorcontrib><creatorcontrib>Rodrigues, José A</creatorcontrib><creatorcontrib>Ramos, Lídia</creatorcontrib><creatorcontrib>Martins, Alexandra</creatorcontrib><creatorcontrib>Karvellas, Constantine J</creatorcontrib><creatorcontrib>Cardoso, Filipe S</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of gastroenterology &amp; hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Oliveira, Ana M</au><au>Branco, Joana C</au><au>Barosa, Rita</au><au>Rodrigues, José A</au><au>Ramos, Lídia</au><au>Martins, Alexandra</au><au>Karvellas, Constantine J</au><au>Cardoso, Filipe S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical and microbiological characteristics associated with mortality in spontaneous bacterial peritonitis: a multicenter cohort study</atitle><jtitle>European journal of gastroenterology &amp; hepatology</jtitle><addtitle>Eur J Gastroenterol Hepatol</addtitle><date>2016-10</date><risdate>2016</risdate><volume>28</volume><issue>10</issue><spage>1216</spage><epage>1222</epage><pages>1216-1222</pages><issn>0954-691X</issn><eissn>1473-5687</eissn><abstract>OBJECTIVESSpontaneous bacterial peritonitis (SBP) is a prevalent and high mortality complication of cirrhosis. We aimed to describe these patients’ clinical and microbiological characteristics and evaluate their impact on outcomes. METHODSThis was a retrospective cohort study including 139 consecutive patients with positive culture SBP from three Portuguese centers diagnosed between 2009 and 2014. Multivariate logistic regression was used to study associations with 30-day mortality. RESULTSThe mean age of the patients was 62 years and 81% of patients were men. The mean model for end-stage liver disease score was 19. Hepatic encephalopathy, hepatorenal syndrome, and variceal bleeding developed in 47, 30, and 21% of patients, respectively. Gram-positive bacteria were isolated in the ascitic fluid of 42% of patients. Resistance to quinolones and multiresistance were found in 33 and 17% of patients, respectively. C-reactive protein level (adjusted odds ratio, 1.16 per 1 mg/l increment) and development of hepatorenal syndrome (adjusted odds ratio, 2.86) were associated independently with 30-day mortality (model’s area under the curve, 0.78). CONCLUSIONIn this cohort, SBP portended high early mortality. Gram-positive bacteria, bacteria resistant to quinolones, and multiresistant bacteria were identified in considerable proportions of patients. In the setting of the high early mortality and changing microbiological profile, SBP management strategies need to be improved.</abstract><cop>England</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>27391170</pmid><doi>10.1097/MEG.0000000000000700</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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subjects Aged
Anti-Bacterial Agents - therapeutic use
Bacterial Infections - diagnosis
Bacterial Infections - drug therapy
Bacterial Infections - microbiology
Bacterial Infections - mortality
Chi-Square Distribution
Drug Resistance, Multiple, Bacterial
Female
Humans
Length of Stay
Liver Cirrhosis - diagnosis
Liver Cirrhosis - microbiology
Liver Cirrhosis - mortality
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Peritonitis - diagnosis
Peritonitis - drug therapy
Peritonitis - microbiology
Peritonitis - mortality
Portugal - epidemiology
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
title Clinical and microbiological characteristics associated with mortality in spontaneous bacterial peritonitis: a multicenter cohort study
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