Choi Jae-Phil, Lee Sang-Oh, Kwon Hyun-Hee, Kwak Yee Gyung, Choi Seong-Ho, Lim Seung Kwan, Kim Mi Na, Jeong Jin-Yong, Choi Sang-Ho, Woo Jun Hee, Kim Yang Soo
Division of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Clin Infect Dis. 2008 Jul 1;47(1):66-72. doi: 10.1086/588665.
Although Aeromonas species are known to cause bacteremia in patients with cirrhosis, less is known about spontaneous bacterial peritonitis (SBP) caused by Aeromonas species in these patients.
We performed a retrospective, matched case-control study (1:2 ratio) consisting of patients presenting with SBP due to Aeromonas species from January 1997 through December 2006. Control subjects were patients with SBP caused by other organisms and were matched to the patients by age (+/- 1 year) and sex.
We identified 43 patients with SBP due to Aeromonas species, 40 (93%) of whom had Aeromonas hydrophila infection and 3 (7%) of whom had Aeromonas sorbia infection. There were 81 control subjects, of whom 38 (47%) were infected with Escherichia coli, 25 (31%) were infected with Klebsiella species, 12 (15%) were infected with Streptococcus species, and 6 (7%) were infected with other bacteria. Baseline Child-Pugh class and model for end-stage liver disease score did not differ between groups. A significant increase in the incidence of infection during the warm season (July-September) was observed in the group with SBP due to Aeromonas species, compared with the group with SBP due to other bacteria (63% vs. 25%; P < .001). Diarrheal episodes were significantly more frequent in the group with SBP due to Aeromonas species (26% vs. 6%; P = .002). There were no statistically significant differences between groups with regard to appropriateness of initial antibiotic therapy,3-day mortality, and 30-day cumulative survival. In the group with Aeromonas infection, the in-hospital mortality rate was 23%; septic shock was the only independent prognostic factor of in-hospital mortality (odds ratio, 34.5;95% confidence interval, 1.9-640.6; P = .02).
Aeromonas species should be considered to be a causative organism of SBP in cirrhotic patients presenting with diarrheal episodes during the warm season. Compared with SBP caused by other organisms, SBP due to Aeromonas species was not associated with more-advanced cirrhosis.
虽然已知气单胞菌属可导致肝硬化患者发生菌血症，但对于这些患者中由气单胞菌属引起的自发性细菌性腹膜炎（SBP）了解较少。
我们进行了一项回顾性配对病例对照研究（1:2比例），研究对象为1997年1月至2006年12月因气单胞菌属导致SBP的患者。对照对象为其他病原体引起SBP的患者，并按年龄（±1岁）和性别与患者进行配对。
我们确定了43例因气单胞菌属导致SBP的患者，其中40例（93%）感染嗜水气单胞菌，3例（7%）感染温和气单胞菌。有81名对照对象，其中38例（47%）感染大肠埃希菌，25例（31%）感染克雷伯菌属，12例（15%）感染链球菌属，6例（7%）感染其他细菌。两组间基线Child-Pugh分级和终末期肝病模型评分无差异。与其他细菌引起SBP的组相比，气单胞菌属引起SBP的组在温暖季节（7 - 9月）感染发生率显著增加（63%对25%；P <.001）。气单胞菌属引起SBP的组腹泻发作明显更频繁（26%对6%；P =.002）。两组在初始抗生素治疗的适宜性、3天死亡率和30天累积生存率方面无统计学显著差异。在气单胞菌感染组，住院死亡率为23%；感染性休克是住院死亡率的唯一独立预后因素（比值比，34.5；95%置信区间，1.9 - 640.6；P =.02）。
对于在温暖季节出现腹泻发作的肝硬化患者，应考虑气单胞菌属为SBP的病原体。与其他病原体引起的SBP相比，气单胞菌属引起的SBP与更晚期肝硬化无关。
