Puri A S, Puri J, Ghoshal U C, Sharma B C, Saraswat V A, Ayyagari A, Naik S R
Department of of Gastroentrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow.
Indian J Gastroenterol. 1996 Jul;15(3):86-9.
To determine the prevalence, microbial spectrum and outcome of spontaneous bacterial peritonitis (SBP) and its variants in hospitalized cirrhotics.
Prospective cohort study at a tertiary referral center in North India.
Over a four-month period, 70 consecutive adult patients with decompensated cirrhosis were screened for the presence of SBP or its variants. Ascitic fluid culture was done by direct inoculation of blood culture bottles at the bedside. Blood, urine and other fluids were cultured during hospital stay when clinically indicated. Ascitic fluid total leukocyte count and culture were repeated at any time during hospital stay if the patient showed clinical signs of deterioration. Patients with SBP and culture-negative neutrocytic ascites (CNNA) were treated empirically on the basis of ascitic fluid leukocyte count.
Twenty-one of 70 (30%) patients with cirrhosis were diagnosed to have SBP or its variants CNNA and monomicrobial bacterascites (MBA). Ninety-five percent of the patients who developed this complication were in Child-Pugh class C. A causative organism was isolated in 62% of these patients. Gram-negative bucilli accounted for 6 of 10 patients with SBP whereas all cases of MBA were due to infection with Gram-positive cocei. A third of patients with SBP/CNNA had evidence of extra-abdominal focus of infection with the same organism. All episodes of SBP/CNNA were initially treated with either ciprofloxacin (12 patients) or a combination of third generation cephalosporin, cefotaxime and an aminoglycoside, gentamicin (n = 6). Fourteen patients (67%) recovered whereas 6 patients died during hospital stay.
SBP is a common complication of decompensated liver disease in North India and is associated with significant in-hospital mortality. Ciprofloxacin is an effective drug for initial treatment of SBP/CNNA. Synchronous extra-peritoneal focus of infection is a frequent occurrence in these patients.
确定住院肝硬化患者自发性细菌性腹膜炎（SBP）及其变异型的患病率、微生物谱和转归。
在印度北部一家三级转诊中心进行的前瞻性队列研究。
在四个月的时间里，对70例连续的失代偿期肝硬化成年患者进行SBP或其变异型的筛查。腹水培养通过在床边直接接种血培养瓶进行。在临床有指征时，住院期间对血液、尿液和其他体液进行培养。如果患者出现临床恶化迹象，住院期间随时重复进行腹水总白细胞计数和培养。SBP和培养阴性的中性粒细胞性腹水（CNNA）患者根据腹水白细胞计数进行经验性治疗。
70例肝硬化患者中有21例（30%）被诊断为患有SBP或其变异型CNNA和单一微生物性腹水（MBA）。发生这种并发症的患者中95%为Child-Pugh C级。这些患者中有62%分离出了病原体。革兰阴性杆菌占10例SBP患者中的6例，而所有MBA病例均由革兰阳性球菌感染引起。三分之一的SBP/CNNA患者有同一病原体引起的腹外感染灶证据。所有SBP/CNNA发作最初均用环丙沙星（12例患者）或第三代头孢菌素头孢噻肟和氨基糖苷类庆大霉素联合治疗（n = 6）。14例患者（67%）康复，6例患者在住院期间死亡。
SBP是印度北部失代偿期肝病的常见并发症，与显著的住院死亡率相关。环丙沙星是SBP/CNNA初始治疗的有效药物。这些患者中常出现同步的腹膜外感染灶。
