Ariza Xavier, Lora-Tamayo Jaime, Castellote José, Xiol Xavier, Ariza Javier
Gastroenterology Department, Hepatology Unit, Hospital Universitari de Bellvitge , Barcelona , Spain.
Scand J Gastroenterol. 2013 Oct;48(10):1213-21. doi: 10.3109/00365521.2013.832367. Epub 2013 Aug 26.
BACKGROUND AND AIMS. In cirrhotic patients with spontaneous bacterial peritonitis (SBP) higher polymorphonuclear (PMN) count in ascitic fluid have been reported in infections caused by Gram-negative bacilli (GNB) as opposed to Gram-positive cocci (GPC). However, the influence of other associated factors on the PMN count, such as the specific microorganism causing the episode of SBP, has not been well established. METHODS. Retrospective observational study of 194 episodes of positive ascitic and/or blood culture SBP in 159 patients with liver cirrhosis (2001-2009). Parameters associated with PMN count in ascitic fluid at diagnosis were evaluated. RESULTS. The multivariate analysis (model 1) showed that a virulent etiology of the infection [coefficient 3.941 (95% confidence interval (95 CI): 0.421-7.461)] and the model for end-stage liver disease (MELD) score [coefficient 0.196 (95 CI: 0.007-0.384)] were positively associated with the PMN count in ascites, while a nosocomial acquisition was inversely associated [coefficient -3.546 (95 CI: -6.855 - -0.238)]. A nonsignificant trend toward higher PMN count was found in GNB versus GPC, but there were differences between groups of microorganisms: pyogenic streptococci [median (p25-p75): 3211 (1615-8004)], Enterobacteriaceae [2958 (917-7690)], Vibrionaceae [9215 (375-17280)], nonfermenting GNB [1384 (565-3865)], viridans group streptococci [1044 (503-2354)] and enterococci [1050 (476-4655)](p = 0.005). No clear cut-offs of ascitic PMN count predicting a particular etiology could be calculated out of these data. CONCLUSIONS. In cirrhotic patients with SBP, the causing microorganism, the place of acquisition of the infection and the host liver condition were the main factors determining PMN count in ascitic fluid. Third-generation cephalosporin resistance was associated with low PMN count probably because this group included bacteria with inherent low virulence.
背景与目的。据报道，在患有自发性细菌性腹膜炎（SBP）的肝硬化患者中，与革兰氏阳性球菌（GPC）相比，革兰氏阴性杆菌（GNB）引起的感染时腹水多形核（PMN）细胞计数更高。然而，其他相关因素对PMN细胞计数的影响，如引起SBP发作的特定微生物，尚未完全明确。方法。对159例肝硬化患者（2001 - 2009年）的194次腹水和/或血培养阳性的SBP发作进行回顾性观察研究。评估诊断时与腹水PMN细胞计数相关的参数。结果。多因素分析（模型1）显示，感染的毒力病因[系数3.941（95%置信区间（95CI）：0.421 - 7.461）]和终末期肝病模型（MELD）评分[系数0.196（95CI：0.007 - 0.384）]与腹水中PMN细胞计数呈正相关，而医院获得性感染则呈负相关[系数 - 3.546（95CI： - 6.855 - - 0.238）]。GNB组与GPC组相比，PMN细胞计数有升高的非显著趋势，但微生物组之间存在差异：化脓性链球菌[中位数（第25 - 75百分位数）：3211（1615 - 8004）]、肠杆菌科[2958（917 - 7690）]、弧菌科[9215（375 - 17280）]、非发酵GNB[1384（565 - 3865）]、草绿色链球菌[1044（503 - 2354）]和肠球菌[1050（476 - 4655）]（p = 0.005）。根据这些数据无法计算出预测特定病因的腹水PMN细胞计数的明确临界值。结论。在患有SBP的肝硬化患者中，致病微生物、感染获得部位和宿主肝脏状况是决定腹水PMN细胞计数的主要因素。第三代头孢菌素耐药与低PMN细胞计数相关，可能是因为该组包括毒力固有较低的细菌。
