Taneja Sunil, Kumar Pramod, Gautam Vikas, Duseja Ajay, Singh Virendra, Dhiman Radha K, Chawla Yogesh
Department of Hepatology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Department of Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
J Clin Exp Hepatol. 2017 Jun;7(2):102-106. doi: 10.1016/j.jceh.2016.08.008. Epub 2016 Aug 28.
complex (Bcc) is non-fermenting Gram-negative bacillus and has been rarely reported to cause spontaneous bacterial peritonitis (SBP) in decompensated cirrhosis.
This study was done to evaluate the clinical presentation of cirrhotic patients with SBP due to Bcc and to determine its impact on clinical outcome.
This is a retrospective, observational study conducted during the period from 1st January 2013 through 31st March 2015. Medical records and microbiology laboratory files were reviewed to identify all cases of Bcc associated SBP among patients hospitalized at the liver intensive care unit and analyzed.
During the study period, out of 252 SBP patients, 11 (4.3%) patients with a positive ascitic fluid culture for Bcc were identified. Pain abdomen was the predominant symptom present in 9 (81%) patients followed by hepatic encephalopathy in 7 (63%) patients. Acute kidney injury (AKI) was universally present, seen in 6 (54%) patients at the time of presentation and 4 (36%) patients developed AKI during hospital stay. The mean CTP score was 11.2 ± 1.1 (10-13), and the mean MELD was 24.3 ± 5.9 (14-35). The mean SOFA and APACHE II score at presentation were 11 ± 4.2 (4-18) and 19.4 ± 5.2 (11-28), respectively. A total of 8 (72%) patients (6-ACLF, 2-NASH) succumbed to the illness during hospitalization due to severe sepsis and multiorgan dysfunction and 3 (27%) patients are doing well on follow-up after 3 months.
SBP caused by Bcc has been rarely reported in cirrhotic patients. This organism is intrinsically resistant to third generation cephalosporins, which are the initial antibiotic of choice for SBP patients, hence associated with multi organ failure and high mortality rates.
嗜麦芽窄食单胞菌是一种非发酵革兰氏阴性杆菌，在失代偿期肝硬化患者中很少报道其可引起自发性细菌性腹膜炎（SBP）。
本研究旨在评估因嗜麦芽窄食单胞菌导致SBP的肝硬化患者的临床表现，并确定其对临床结局的影响。
这是一项回顾性观察研究，研究时间为2013年1月1日至2015年3月31日。回顾了病历和微生物学实验室文件，以确定在肝脏重症监护病房住院的患者中所有与嗜麦芽窄食单胞菌相关的SBP病例并进行分析。
在研究期间，252例SBP患者中，有11例（4.3%）腹水培养嗜麦芽窄食单胞菌呈阳性。9例（81%）患者以腹痛为主要症状，其次7例（63%）患者出现肝性脑病。急性肾损伤（AKI）普遍存在，6例（54%）患者在就诊时出现AKI，4例（36%）患者在住院期间发生AKI。平均CTP评分为11.2±1.1（10 - 13），平均终末期肝病模型（MELD）评分为24.3±5.9（14 - 35）。就诊时平均序贯器官衰竭评估（SOFA）评分和急性生理与慢性健康状况评分系统II（APACHE II）评分分别为11±4.2（4 - 18）和19.4±5.2（11 - 28）。共有8例（72%）患者（6例急性肝衰竭 - 慢性肝病急性加重，2例非酒精性脂肪性肝炎）因严重脓毒症和多器官功能障碍在住院期间死亡，3例（27%）患者在3个月随访时情况良好。
嗜麦芽窄食单胞菌引起的SBP在肝硬化患者中很少见。该菌对第三代头孢菌素具有固有耐药性，而第三代头孢菌素是SBP患者的初始首选抗生素，因此与多器官衰竭和高死亡率相关。
