Senior Resident; Department of Medical Gastroenterology, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India.
Senior Resident; Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India.
J Assoc Physicians India. 2022 Jun;70(6):11-12. doi: 10.5005/japi-11001-0023.
Spontaneous ascitic fluid infection (SAI) is common in cirrhotic patients leading to significant morbidity and mortality. Third-generation cephalosporins are currently recommended as first-line therapy. This is a retrospective observational study that aims to determine bacterial etiology, susceptibility patterns of SAI, and its correlation with model for end-stage liver disease-sodium (MELD-Na) and Child-Turcotte-Pugh (CTP) score.
The present study was conducted on 274 consecutive cases admitted in Bombay Hospital and Medical Research Centre, Mumbai, India. Cases of cirrhosis (irrespective of etiology) with ascites between the ages of 18-85 years were included in this study. Ascitic fluid of every patient was aspirated under all aseptic measures and was sent for biochemical, culture, and cytological analysis.
Of the 274 patients studied, 34 (12.4%) patients were diagnosed to have SAI. Culture-negative neutrocytic ascites (CNNA) was present in 27 patients, spontaneous bacterial peritonitis (SBP) was present in six patients, and monomicrobial bacteriascites was seen in one patient. Mean age of patients enrolled was 56.05 ± 2.47 years. Eighty-two percent were males and 18% were females. Alcohol (45.45%) was the leading cause of cirrhosis followed by nonalcoholic steatohepatitis (NASH) related cirrhosis (26.47.7%) and hepatitis C virus (HCV) related cirrhosis (11.46%) and cryptogenic cirrhosis (8.82%). Average MELD-Na score was 25 and the CTP class C was most common. Klebsiella pneumoniae was the most commonly isolated organism followed by Escherichia coli. The various factors that predispose to development of SBP include low ascitic fluid protein concentration, a high level of serum bilirubin, deranged serum creatinine, high Child-Pugh score, and high MELD-Na score.
Ascitic fluid analysis remains the single most important test for identifying and assessing a course of SBP. Early diagnosis and treatment will reduce the mortality rate in these patients.
自发性腹水感染（SAI）在肝硬化患者中很常见，导致发病率和死亡率显著增加。第三代头孢菌素目前被推荐为一线治疗药物。这是一项回顾性观察研究，旨在确定 SAI 的细菌病因、药敏模式及其与终末期肝病模型钠（MELD-Na）和 Child-Turcotte-Pugh（CTP）评分的相关性。
本研究在印度孟买的 Bombay Hospital and Medical Research Centre 对 274 例连续病例进行了研究。本研究纳入了年龄在 18-85 岁之间的、患有肝硬化（无论病因如何）且伴有腹水的患者。在所有无菌措施下抽取每位患者的腹水，并进行生化、培养和细胞学分析。
在 274 例研究患者中，有 34 例（12.4%）患者被诊断为患有 SAI。27 例存在培养阴性中性粒细胞性腹水（CNNA），6 例存在自发性细菌性腹膜炎（SBP），1 例存在单一细菌性腹水。纳入患者的平均年龄为 56.05 ± 2.47 岁。82%为男性，18%为女性。肝硬化的主要病因是酒精（45.45%），其次是非酒精性脂肪性肝炎（NASH）相关肝硬化（26.47%）、丙型肝炎病毒（HCV）相关肝硬化（11.46%）和隐源性肝硬化（8.82%）。平均 MELD-Na 评分为 25，CTP 分级 C 最常见。最常分离出的病原体是肺炎克雷伯菌，其次是大肠杆菌。易发生 SBP 的各种因素包括腹水蛋白浓度低、血清胆红素水平高、血清肌酐水平异常、Child-Pugh 评分高和 MELD-Na 评分高。
腹水分析仍然是确定和评估 SBP 病程的最重要的单一检查。早期诊断和治疗将降低这些患者的死亡率。
