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Raguž F, Tomić M, Stojčić A, Tipurić M, Volarić M, Bevanda S. Peritoneal dialysis in Herzegovina, Federation of Bosnia and Herzegovina: 18 years of experience from our center. Ther Apher Dial 2024; 28:409-416. [PMID: 38115783 DOI: 10.1111/1744-9987.14097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Due to treatment of end-stage-renal-disease (ESRD), continuous peritoneal dialysis (CAPD) is used in 11% of cases and is associated with several PD-associated infections. METHODS Clinical data on 71 patients with CAPD were evaluated in addition to exit site infections and episodes of acute peritonitis (AP). RESULTS There were 39 men and 32 women. Average age was 61 years when we began CAPD and average time spent on CAPD program was 3.35 years. Illness that dominantly caused ESRD was diabetes (23 patients). Exit site infection was mostly caused by S epidermidis-MRSE and AP was most commonly caused by Staphylococcus sp. group. Most common cause of death was cardiovascular disease. At the end of this study, 9 patients were alive and still on CAPD, 10 were transplanted, 15 switched to HD and 36 died. CONCLUSION Optimal prevention measures and treatment of infectious complications in CAPD is necessary for better treatment possibilities.
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Affiliation(s)
- Fila Raguž
- Department of Nephrology, Division of Internal Medicine with Centre for Dialysis, University Hospital Mostar, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina
| | - Monika Tomić
- Department of Nephrology, Division of Internal Medicine with Centre for Dialysis, University Hospital Mostar, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina
| | - Andrea Stojčić
- Department of Nephrology, Division of Internal Medicine with Centre for Dialysis, University Hospital Mostar, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina
| | - Manuel Tipurić
- Department of Urology, University Hospital Mostar, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina
| | - Mile Volarić
- Department of Gastroenterology, Division of Internal Medicine with Centre for Dialysis, University Hospital Mostar, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina
| | - Sanja Bevanda
- Department of Endocrinology, Division of Internal Medicine with Centre for Dialysis, University Hospital Mostar, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina
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Mallart E, Guerin F, Amoura A, Le Scouarnec M, Hamon A, El Meouche I, Chau F, Lefort A, Fantin B, Cattoir V, de Lastours V. Impact of the phenotypic expression of temocillin resistance in Escherichia coli on temocillin efficacy in a murine peritonitis model. J Antimicrob Chemother 2024; 79:1051-1059. [PMID: 38501355 DOI: 10.1093/jac/dkae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/29/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Temocillin is a narrow spectrum β-lactam active against MDR Enterobacterales. Mechanisms of acquired resistance to temocillin are poorly understood. We analysed resistance mechanisms in clinical isolates of Escherichia coli and evaluated their impact on temocillin efficacy in vitro and in a murine peritonitis model. METHODS Two sets of isogenic clinical E. coli strains were studied: a susceptible isolate (MLTEM16S) and its resistant derivative, MLTEM16R (mutation in nmpC porin gene); and temocillin-resistant derivatives of E. coli CFT073: CFT-ΔnmpC (nmpC deletion), CFTbaeS-TP and CFTbaeS-AP (two different mutations in the baeS efflux-pump gene).Fitness cost, time-kill curves and phenotypic expression of resistance were determined. Temocillin efficacy was assessed in a murine peritonitis model. RESULTS MICs of temocillin were 16 and 64 mg/L for MLTEM16S and MLTEM16R, respectively, and 8, 128, 256 and 256 mg/L for E. coli-CFT073, CFT-ΔnmpC, CFTbaeS-TP and CFTbaeS-AP, respectively. No fitness cost of resistance was evidenced. All resistant strains showed heteroresistant profiles, except for CFTbaeS-AP, which displayed a homogeneous pattern. In vitro, temocillin was bactericidal against MLTEM16R, CFT-ΔnmpC, CFTbaeS-TP and CFTbaeS-AP at 128, 256, 512 and 512 mg/L, respectively. In vivo, temocillin was as effective as cefotaxime against MLTEM16R, CFT-ΔnmpC and CFTbaeS-TP, but inefficient against CFTbaeS-AP (100% mortality). CONCLUSIONS Heteroresistant NmpC porin alteration and active efflux modification do not influence temocillin efficacy despite high MIC values, unfavourable pharmacokinetic/pharmacodynamic conditions and the absence of fitness cost, whereas homogeneously expressed BaeS efflux pump alteration yielding similar MICs leads to temocillin inefficacy. MIC as sole predictor of temocillin efficacy should be used with caution.
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Affiliation(s)
- Elise Mallart
- IAME Research Group, UMR1137 INSERM and Uiversité Paris Cité, F-75018 Paris, France
| | - François Guerin
- UMR1230, INSERM and Université Rennes 1, F-35043 Rennes, France
- Service de Bactériologie-Hygiène Hospitalière & CNR de la Résistance aux Antibiotiques (laboratoire associé 'Entérocoques'), CHU Pontchaillou, F-35033 Rennes, France
| | - Ariane Amoura
- IAME Research Group, UMR1137 INSERM and Uiversité Paris Cité, F-75018 Paris, France
| | - Matthieu Le Scouarnec
- Service de Bactériologie-Hygiène Hospitalière & CNR de la Résistance aux Antibiotiques (laboratoire associé 'Entérocoques'), CHU Pontchaillou, F-35033 Rennes, France
| | - Antoine Hamon
- IAME Research Group, UMR1137 INSERM and Uiversité Paris Cité, F-75018 Paris, France
| | - Imane El Meouche
- IAME Research Group, UMR1137 INSERM and Uiversité Paris Cité, F-75018 Paris, France
| | - Françoise Chau
- IAME Research Group, UMR1137 INSERM and Uiversité Paris Cité, F-75018 Paris, France
| | - Agnès Lefort
- IAME Research Group, UMR1137 INSERM and Uiversité Paris Cité, F-75018 Paris, France
- Service de Médecine Interne, Hôpital Beaujon, AP-HP, Université Paris Cité, F-92210 Clichy, France
| | - Bruno Fantin
- IAME Research Group, UMR1137 INSERM and Uiversité Paris Cité, F-75018 Paris, France
- Service de Médecine Interne, Hôpital Beaujon, AP-HP, Université Paris Cité, F-92210 Clichy, France
| | - Vincent Cattoir
- UMR1230, INSERM and Université Rennes 1, F-35043 Rennes, France
- Service de Bactériologie-Hygiène Hospitalière & CNR de la Résistance aux Antibiotiques (laboratoire associé 'Entérocoques'), CHU Pontchaillou, F-35033 Rennes, France
| | - Victoire de Lastours
- IAME Research Group, UMR1137 INSERM and Uiversité Paris Cité, F-75018 Paris, France
- Service de Médecine Interne, Hôpital Beaujon, AP-HP, Université Paris Cité, F-92210 Clichy, France
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Cho Y, Chow KM, Kam-Tao Li P, Runnegar N, Johnson DW. Peritoneal Dialysis-Related Infections. Clin J Am Soc Nephrol 2024; 19:641-649. [PMID: 37574658 DOI: 10.2215/cjn.0000000000000280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
Peritoneal dialysis (PD) represents an important treatment choice for patients with kidney failure. It allows them to dialyze outside the hospital setting, facilitating enhanced opportunities to participate in life-related activities, flexibility in schedules, time and cost savings from reduced travel to dialysis centers, and improved quality of life. Despite its numerous advantages, PD utilization has been static or diminishing in parts of the world. PD-related infection, such as peritonitis, exit-site infection, or tunnel infection, is a major concern for patients, caregivers, and health professionals-which may result in hesitation to consider this as treatment or to cease therapy when these complications take place. In this review, the definition, epidemiology, risk factors, prevention, and treatment of PD-related infection on the basis of the contemporary evidence will be described.
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Affiliation(s)
- Yeoungjee Cho
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Kai-Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Naomi Runnegar
- Infectious Management Services, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
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Obermueller M, Traby L, Weiss-Tessbach M, Kriz R, Spettel K, Schneider L, Hohl L, Burgmann H, Kussmann M. Staphylococcus aureus small colony variants: A potentially underestimated microbiological challenge in peritoneal dialysis. Int J Antimicrob Agents 2024; 63:107135. [PMID: 38458357 DOI: 10.1016/j.ijantimicag.2024.107135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 02/03/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION Peritonitis remains the major infectious complication in the setting of peritoneal dialysis (PD). Despite known only moderate pathogenicity, the most frequently detected pathogens in PD-related peritonitis are surprisingly coagulase-negative staphylococci. However, this could be explained, at least in part, by Staphylococcus aureus small colony variants (SCVs) induced by PD fluids (PDFs) and misidentified by routinely used microbiological methods. MATERIAL AND METHODS Bacteria were exposed to commonly used PDFs in various regimens designed to simulate daily use as closely as possible. Wild-type isolates and SCVs were subsequently used to determine minimum inhibitory concentrations (MICs), in vitro biofilm formation capacities, and auxotrophies. Underlying genetic alterations were investigated using whole-genome sequencing, and various microbial identification methods were tested to determine their performance for wild-types and SCVs. RESULTS Stable SCVs could be isolated most successfully after exposure to glucose-containing PDFs alone. The reading of MICs was significantly affected by the reduced growth of SCVs, resulting in lower MIC values in 44% of all tests. Nonsynonymous mutations were found in all but one SCV, while only two isolates showed typical auxotrophic responses. While MALDI-TOF, PCR and Pastorex Staph-Plus correctly identified all S. aureus SCVs, API-Staph and VITEK-2 yielded identification rates of only 40% and 10%, respectively. CONCLUSIONS Overall, the present study has shown that commercially available PDFs induce S. aureus SCVs in vitro, which are difficult to identify and test for antimicrobial susceptibility and can potentially lead to recurrent or persistent infections. Thus, they represent a potentially underappreciated challenge not only for microbiologists, but also for clinicians.
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Affiliation(s)
- Markus Obermueller
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Ludwig Traby
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Matthias Weiss-Tessbach
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria; Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Richard Kriz
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Kathrin Spettel
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Vienna, Austria
| | - Lisa Schneider
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Lena Hohl
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Heinz Burgmann
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Manuel Kussmann
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria.
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Matsumoto Y, Shimizu A, Ogawa K, Kuroki S, Ikuta K, Senda E, Kagawa H, Shio S. Primary Peritonitis Due to Group A Streptococcus Successfully Treated with Intraperitoneal Drainage. Intern Med 2024; 63:1229-1235. [PMID: 37722896 DOI: 10.2169/internalmedicine.1933-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
A 42-year-old woman was admitted to our hospital because of lower abdominal pain and diarrhea. Although the initial symptoms and imaging findings were similar to those of acute enteritis, blood and ascites cultures led to the diagnosis of primary peritonitis caused by group A Streptococcus. In many cases, the disease rapidly deteriorates, and laparotomy is performed for the early diagnosis and to reduce the number of bacteria in the abdominal cavity. In the present case, intraperitoneal drainage was effective for avoiding surgery. We suggest that intraperitoneal drainage is effective for the treatment of this disease.
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Affiliation(s)
| | - Akiko Shimizu
- Division of Gastroenterology, Shinko Hospital, Japan
| | - Kento Ogawa
- Division of Gastroenterology, Shinko Hospital, Japan
| | | | - Kozo Ikuta
- Division of Gastroenterology, Shinko Hospital, Japan
| | - Eri Senda
- Division of Gastroenterology, Shinko Hospital, Japan
| | - Hiroki Kagawa
- Division of Infectious Diseases, Shinko Hospital, Japan
| | - Seiji Shio
- Division of Gastroenterology, Shinko Hospital, Japan
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You L, Zhang B, Zhang F, Wang J. Pathogenic spectrum and risk factors of peritoneal dialysis-associated peritonitis: a single-center retrospective study. BMC Infect Dis 2024; 24:440. [PMID: 38658811 PMCID: PMC11044422 DOI: 10.1186/s12879-024-09334-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
The present study aimed to explore the pathogenic spectrum and risk factors of peritoneal dialysis-associated peritonitis (Peritoneal dialysis associated peritonitis, PDAP) in Yongzhou, Hunan, China. The clinical and epidemiological data on regular peritoneal dialysis (Peritoneal dialysis, PD) between January 2016 and December 2020 in Yongzhou were collected for retrospective analysis. The related factors of peritonitis were evaluated by single-factor analysis, while risk factors of refractory PDAP were evaluated by multivariate logistic regression analysis.172/331 172 (51.9%) patients developed peritonitis. The risk factors of PDAP in PD patients included high C-reactive protein (C-reactive protein, CRP), low albumin(Albumin, ALB), low hemoglobin (Hemoglobin, Hb), low educational level (junior high school or lower), preference of spicy food, irregular diet, low annual household income, unfavorable fluid exchange conditions, unstable employment (including working as a farmer), and unfavorable humidity conditions (P < 0.05). 63/172 (36.6%) PDAP patients were intractable cases with a pathogenic bacteria positive rate of 74.60% in the peritoneal dialysate cultures, and 109/172 patients were non-intractable cases with a pathogenic bacteria positive rate of 53.21%. Gram-positive bacteria (G+) were detected in most of the dialysate cultures, with Staphylococcus epidermidis (S. epidermidis) as the most common type, while Escherichia coli (E. coli) was the most common Gram-negative bacteria (G-). Gram-positive bacteria were sensitive to vancomycin and linezolid, while G- bacteria were sensitive to imipenem and amikacin. Lifestyle, educational level, and environmental factors are the major contributors to PDAP in PD patients. Fungal and multi-bacterial infections are the major causes of death; PD is stopped for such patients.
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Affiliation(s)
- Linshuang You
- Department of Nephropathy, The Central Hospital of Yongzhou, Yongzhou, China
| | - Baoguo Zhang
- Department of Nephropathy, The Central Hospital of Yongzhou, Yongzhou, China
| | - Fan Zhang
- Department of Nephropathy, The Central Hospital of Yongzhou, Yongzhou, China
| | - Jianwen Wang
- Department of Nephropathy, Third Xiangya Hospital of Central South University, Changsha, Hunan Province, 410013, China.
- Department of Critical Kidney Disease Research Center, Third Xiangya Hospital of Central South University, Changsha, China.
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Zhou J, Huang Y, Zhang X, Xiong L, Zhang R, Shi H. Intraperitoneal vancomycin plus levofloxacin for the treatment of peritoneal dialysis-related peritonitis in patients with no response to cefazolin plus ceftazidime. Clin Nephrol 2024; 101:164-170. [PMID: 38329920 DOI: 10.5414/cn111186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Peritoneal dialysis-related peritonitis (PDRP) should be treated as soon as possible by an empirical regimen without waiting for effluent bacterial culture results. We retrospectively investigated patients treated with vancomycin plus levofloxacin as a treatment regimen if there was no response to cefazolin plus ceftazidime. MATERIALS AND METHODS We collected records of adult patients with PDRP from January 1, 2013, to November 30, 2020. The characteristics of episodes of PDRP with no response to cefazolin plus ceftazidime treated by intraperitoneal (IP) injection of vancomycin plus levofloxacin were analyzed. RESULTS 118 episodes of PDRP were recorded, among which 115 episodes were treated with IP antibiotics. 93 episodes were treated with cefazolin plus ceftazidime. In 38 episodes, treatment was switched to IP injection of vancomycin plus levofloxacin if there was no response to cefazolin plus ceftazidime. 26/38 (68.4%) episodes were cured by vancomycin plus levofloxacin. Fever, diabetes, fasting glucose, a decrease in effluent leukocytes on day 3 and day 5, and Charlson Comorbidity Index (CCI) scores were significantly different between uncured and cured episodes. No variable was associated with treatment failure after multiple logistic regression. Fever, diabetes, a decrease in effluent leukocytes on day 3, and CCI score were associated with treatment failure after univariable logistic regression. CONCLUSION Vancomycin plus levofloxacin may be effective if patients are not responsive to cefazolin plus ceftazidime.
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Manzulli V, Schiavone A, Castellana S, Albenzio M, Cafiero MA, Camarda A, Capozzi L, D'Angelo F, Parisi A, Vasco I, Sciancalepore D, Marino L, Serrecchia L, Rondinone V, Campaniello M, Crescenzo G, Galante D, Pugliese N. Psychrobacter raelei sp. nov., isolated from a dog with peritonitis. Int J Syst Evol Microbiol 2024; 74. [PMID: 38683659 DOI: 10.1099/ijsem.0.006353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
A strain belonging to the genus Psychrobacter, named PraFG1T, was isolated from the peritoneal effusion of a stray dog during necropsy procedures. The strain was characterized by the phylogenetic analyses based on the nucleotide sequences of 16S and 23S rRNA genes and of gyrB, which placed the strain in the genus Psychrobacter. The nucleotide sequence of the chromosome confirmed the placement, showing an average nucleotide identity of 72.1, 77.7, and 77.5 % with the closest related species, namely Psychrobacter sanguinis, Psychrobacter piechaudii, and Psychrobacter phenylpyruvicus, respectively, thus indicating a novel species. The polyphasic characterization by biochemical and fatty acid profiling as well as MALDI-TOF supported those findings. The strain was halotolerant, capable of growing within a temperature range between 4 and 37 °C, it was positive for catalase and oxidase, indole producing, nitrate reducing, and not able to use 5-keto-d-gluconic acid as a carbon source. Taken together, the data suggest that strain PraFG1T could be considered as representing a novel species, with the name Psychrobacter raelei sp. nov. (type strain PraFG1T=CIP 111873T=LMG 32233T).
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Affiliation(s)
- Viviana Manzulli
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Foggia, Italy
| | - Antonella Schiavone
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Valenzano, Italy
- Moredun Research Institute, Edinburgh, UK
| | - Stefano Castellana
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Putignano, Italy
| | - Marzia Albenzio
- Dipartimento di Scienze Agrarie, Alimenti, Risorse naturali e Ingegneria, Università di Foggia, Foggia, Italy
| | - Maria Assunta Cafiero
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Foggia, Italy
| | - Antonio Camarda
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Valenzano, Italy
| | - Loredana Capozzi
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Putignano, Italy
| | - Francesca D'Angelo
- Dipartimento di Scienze Agrarie, Alimenti, Risorse naturali e Ingegneria, Università di Foggia, Foggia, Italy
| | - Antonio Parisi
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Putignano, Italy
| | - Ilaria Vasco
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Foggia, Italy
| | - Dario Sciancalepore
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Valenzano, Italy
| | - Leonardo Marino
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Foggia, Italy
| | - Luigina Serrecchia
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Foggia, Italy
| | - Valeria Rondinone
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Foggia, Italy
| | - Maria Campaniello
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Foggia, Italy
| | - Giuseppe Crescenzo
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Valenzano, Italy
| | - Domenico Galante
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Foggia, Italy
| | - Nicola Pugliese
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Valenzano, Italy
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Badal J, Badal B, Nawras M, Lee-Smith W, Stanley S, Hassan M, Ahmed Z. Diagnostic Paracentesis Within 1 Day Is Associated With Reduced Mortality and Length of Hospital Stay in Patients with Cirrhosis and Ascites. Dig Dis Sci 2024; 69:1454-1466. [PMID: 38217676 DOI: 10.1007/s10620-023-08249-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 10/09/2023] [Indexed: 01/15/2024]
Abstract
Spontaneous bacterial peritonitis (SBP) is the most common infection in patients with cirrhosis and is associated with high mortality. Although recent literature reports mortality benefits to early diagnostic paracentesis, current guidelines do not offer specific recommendations for how quickly diagnostic paracentesis should be performed in patients with cirrhosis and ascites who are admitted to the hospital. Therefore, we conducted a systematic review and meta-analysis to evaluate outcomes among patients admitted to the hospital with cirrhosis and ascites receiving paracentesis within ≤ 12, ≤ 1 day, and > 1 day. Eight studies with 116,174 patients were included in the final meta-analysis. The pooled risk of in-hospital mortality was significantly lower in patients who underwent early (≤ 12 h or ≤ 1 day) compared to delayed (> 12 h or > 1 day) paracentesis (RR: 0.69, p < 0.00001), and in patients who underwent paracentesis compared to no paracentesis (RR: 0.74, p < 0.00001). On subgroup analysis, in-hospital mortality was significantly lower in both paracentesis within ≤ 12 h (RR: 0.61, p = 0.02) vs. > 12 h, and within ≤ 1 day (RR: 0.70, p < 0.00001) vs. > 1 day. While there was a trend towards decreased mortality in those undergoing paracentesis within ≤ 12 h compared to ≤ 1 day, the difference did not reach statistical significance. The length of hospital stay was significantly shorter by 5.38 days in patients who underwent early (≤ 12 h) compared to delayed (> 12 h) paracentesis (95% CI 4.24-6.52, p < 0.00001). Early paracentesis is associated with reduced mortality and length of hospital stay. We encourage providers to perform diagnostic paracentesis in a timely manner, at least within 1 day of hospital admission, for all patients with cirrhosis and ascites.
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Affiliation(s)
- Joyce Badal
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
- UNC Faculty Physicians Center, 100 Eastowne Drive, Chapel Hill, NC, 27514, USA.
| | - Bryan Badal
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, VA, USA
| | - Mohamad Nawras
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | | | - Sara Stanley
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Mona Hassan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Zohaib Ahmed
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA
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Mani I, Alexopoulou A. Spontaneous bacterial peritonitis- Is hepatocellular carcinoma an aggravating prognostic factor? Am J Med Sci 2024; 367:153-154. [PMID: 38135275 DOI: 10.1016/j.amjms.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Iliana Mani
- 2nd Department of Internal Medicine, Medical School, National & Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Alexandra Alexopoulou
- 2nd Department of Internal Medicine, Medical School, National & Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
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Abdel-Samiee M, Awad SM, Mohamed AA, Abdelsameea E, Taha HAL. Prognosis of spontaneous bacterial peritonitis in patients with hepatocellular carcinoma. Am J Med Sci 2024; 367:171-180. [PMID: 38042406 DOI: 10.1016/j.amjms.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/27/2023] [Accepted: 11/24/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the fourth leading cause of death from cancer worldwide. Spontaneous bacterial peritonitis (SBP) is associated with poor prognosis. This study aimed to evaluate risk factors, differences in clinical characteristics and prognosis of SBP in patients with HCC in comparison with non-HCC patients. METHODS This study was conducted on patients with cirrhosis who were admitted to hospital with SBP. The patients were divided into two groups: SBP group with HCC (n = 150) and SBP group without HCC (n = 250). RESULTS Men and women accounted for 72% and 28% (n = 108 and 42, respectively) of the population in SBP group with HCC with mean age 55.8 ± 13.1 years. They accounted for 68.4% and 31.6% (n = 171 and 79, respectively) in the SBP group without HCC with mean age 56.8 ± 10.5 years. In-hospital mortality was 25.3% in the SBP group with HCC and 18.8% in SBP group without HCC. Gastrointestinal bleeding was the most common cause of death in both groups. No significant difference was observed in patient outcomes between the two studied groups. The deceased patients had significantly higher levels of leukocytes and neutrophils in ascitic fluid as well as a higher frequency of positive culture results than in patients who survived (p < 0.001). However, there was no significant difference in protein level in ascitic fluid or causative organism between patients who survived and those who died (p = 0.63 and 0.19, respectively). CONCLUSIONS Prognosis of SBP in patients with HCC seemed similar to that in patients without HCC.
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Affiliation(s)
- Mohamed Abdel-Samiee
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt
| | - Samah Mohammad Awad
- Clinical Microbiology and Immunology and Molecular Microbiology in Liver and GIT Department, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt
| | | | - Eman Abdelsameea
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt.
| | - Hussam Abdel-Latif Taha
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt
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12
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Zhang M, Zhang X, Yin X, Li G, Yang T, Xie D, Chen C. Peritoneal dialysis-associated peritonitis caused by Neisseria.sicca: A case report and literature review. Indian J Med Microbiol 2024; 48:100566. [PMID: 38522747 DOI: 10.1016/j.ijmmb.2024.100566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 03/26/2024]
Abstract
Neisseria sicca, a Gram-negative diplococcus commonly found in the nasopharynx as part of normal bacterial flora, is typically non-pathogenic but has been associated with various diseases including endocarditis, conjunctivitis, pneumonia and meningitis (Jeurissen et al., 2006; Kozlova et al., 2020; Alcid, 1980; Carter et al., 2007). In this report, we present a case of peritonitis in a patient undergoing peritoneal dialysis caused by N. sicca and review the literature on Neisseria-associated peritonitis.
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Affiliation(s)
| | - XuZhan Zhang
- Laboratory Department of Heze Municipal Hospital, China.
| | - Xin Yin
- Laboratory Department of Heze Municipal Hospital, China.
| | - GuiXia Li
- Laboratory Department of Heze Municipal Hospital, China.
| | - Tian Yang
- Intensive Care Unit of Heze Traditional Chinese Medicine Hospital, China.
| | - Di Xie
- Laboratory Department of Heze Municipal Hospital, China.
| | - Chen Chen
- Laboratory Department of Heze Municipal Hospital, China.
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13
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Yang CJ, Song JS, Yoo JJ, Park KW, Yun J, Kim SG, Kim YS. 16S rRNA Next-Generation Sequencing May Not Be Useful for Examining Suspected Cases of Spontaneous Bacterial Peritonitis. Medicina (Kaunas) 2024; 60:289. [PMID: 38399576 PMCID: PMC10890036 DOI: 10.3390/medicina60020289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/28/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Ascites, often associated with liver cirrhosis, poses diagnostic challenges, particularly in detecting bacterial infections. Traditional methods have limitations, prompting the exploration of advanced techniques such as 16S rDNA next-generation sequencing (NGS) for improved diagnostics in such low-biomass fluids. The aim of this study was to investigate whether the NGS method enhances detection sensitivity compared to a conventional ascites culture. Additionally, we aimed to explore the presence of a microbiome in the abdominal cavity and determine whether it has a sterile condition. Materials and Methods: Ten patients with clinically suspected spontaneous bacterial peritonitis (SBP) were included in this study. A traditional ascites culture was performed, and all ascites samples were subjected to 16S ribosomal RNA gene amplification and sequencing. 16S rRNA gene sequencing results were interpreted by comparing them to positive and negative controls for each sample. Results: Differential centrifugation was applied to all ascites samples, resulting in very small or no bacterial pellets being harvested. The examination of the 16S amplicon sequencing libraries indicated that the target amplicon products were either minimally visible or exhibited lower intensity than their corresponding negative controls. Contaminants present in the reagents were also identified in the ascites samples. Sequence analysis of the 16S rRNA gene of all samples showed microbial compositions that were akin to those found in the negative controls, without any bacteria isolated that were unique to the samples. Conclusions: The peritoneal cavity and ascites exhibit low bacterial biomass even in the presence of SBP, resulting in a very low positivity rate in 16S rRNA gene sequencing. Hence, the 16S RNA sequencing method does little to enhance the rate of positive samples compared to traditional culture methods, including in SBP cases.
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Affiliation(s)
- Chan Jin Yang
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Republic of Korea; (C.J.Y.); (J.Y.); (S.G.K.); (Y.S.K.)
| | - Ju Sun Song
- GC Genome, Department of Laboratory Medicine, Green Cross Laboratories, Youngin 16924, Republic of Korea;
| | - Jeong-Ju Yoo
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Republic of Korea; (C.J.Y.); (J.Y.); (S.G.K.); (Y.S.K.)
| | - Keun Woo Park
- Preclinical Stroke Modeling Laboratory Weill Cornell Medicine, Burke Medical Research Institute, White Plains, NY 10605, USA;
| | - Jina Yun
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Republic of Korea; (C.J.Y.); (J.Y.); (S.G.K.); (Y.S.K.)
| | - Sang Gyune Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Republic of Korea; (C.J.Y.); (J.Y.); (S.G.K.); (Y.S.K.)
| | - Young Seok Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Republic of Korea; (C.J.Y.); (J.Y.); (S.G.K.); (Y.S.K.)
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14
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Hadano Y. Use of Blood Culture Bottles in the Diagnosis of Spontaneous Bacterial Peritonitis. Intern Med 2024; 63:465. [PMID: 37258155 PMCID: PMC10901712 DOI: 10.2169/internalmedicine.2023-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Affiliation(s)
- Yoshiro Hadano
- Division of Infection Control and Prevention, Shimane University Hospital, Japan
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15
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Sbeit W, Maamoun B, Azzam S, Shahin A, Carmiel-Haggai M, Khoury T. Ascites fluid calprotectin level is highly accurate in diagnosing spontaneous bacterial peritonitis: a preliminary proof of concept prospective study. Clin Exp Med 2024; 24:25. [PMID: 38281236 PMCID: PMC10822801 DOI: 10.1007/s10238-023-01257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/15/2023] [Indexed: 01/30/2024]
Abstract
Ascites is the most common complication of liver cirrhosis. Spontaneous bacterial peritonitis (SBP) is a common complication of ascites. The diagnosis is made by an ascitic fluid polymorphonuclear (PMN) cell count of ≥ 250/mm3. However, no other diagnostic test is present for the diagnosis of SBP. The aim of the study present study is to assess the diagnostic yield of ascitic calprotectin in SBP, and to explore whether it can predict disease stage. We performed a single center proof-of-concept prospective study including all patients with cirrhosis and ascites who underwent paracentesis. Overall, 31 patients were included in the study. Eight patients had SBP vs. 23 patients without SBP. Ascitic calprotectin level was 77.4 ± 86.5 μg/mL in the SBP group, as compared to 16.1 ± 5.6 μg/mL in the non-SBP group (P = 0.001). An ascitic calprotectin cut-off value of > 21 μg/mL was associated with sensitivity and specificity of 85.7% and 89.5%, respectively, with ROC of 0.947 (95% CI 0.783 to 0.997, P < 0.0001). Notably, ascitic calprotectin did not had a prognostic value in cirrhosis stage and prognosis. Ascitic calprotectin was highly accurate in the diagnosis of SBP. It can be a serve as adjunct for indefinite cases of SBP.
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Affiliation(s)
- Wisam Sbeit
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, 1311502, Israel
| | - Basheer Maamoun
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, 1311502, Israel
| | - Subhi Azzam
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
| | - Amir Shahin
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, 1311502, Israel
| | - Michal Carmiel-Haggai
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, 1311502, Israel
- Liver Unit, Galilee Medical Center, Nahariya, Israel
| | - Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, 1311502, Israel.
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16
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Tawhari I, Saggese S, Alshahrani SS, Asiri G, Alshahrani SA, Summan S, Al Qasim YY, Al Majbar YA. Peritoneal Dialysis-Associated Peritonitis Caused by Achromobacter xylosoxidans: A Case Report and Literature Review. J Investig Med High Impact Case Rep 2024; 12:23247096231220467. [PMID: 38164897 PMCID: PMC10762871 DOI: 10.1177/23247096231220467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/04/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
Achromobacter xylosoxidans is a gram-negative bacterium that is responsible for rare peritonitis associated with peritoneal dialysis (PD). We present a case of a 64-year-old woman with a medical history of end-stage renal disease undergoing PD who was admitted to the emergency department with abdominal pain and nausea. Physical examination and laboratory studies revealed peritoneal signs and laboratory abnormalities consistent with peritonitis. Intraperitoneal catheter dysfunction was identified and subsequently resolved via laparoscopy. Following a peritoneal fluid culture, A xylosoxidans was identified, leading to the initiation of intraperitoneal meropenem treatment. After an initial improvement, the patient developed an ileus and recurrent abdominal symptoms, and further peritoneal cultures remained positive for A xylosoxidans. Subsequent treatment included intravenous meropenem and vancomycin for Clostridium difficile colitis. Owing to the high likelihood of biofilm formation on the PD catheter by A xylosoxidans, the catheter was removed, and the patient transitioned to hemodialysis. Intravenous meropenem was continued for 2 weeks post-catheter removal. This case highlights the challenges in managing recurrent peritonitis in PD patients caused by multidrug-resistant A xylosoxidans. A high index of suspicion, appropriate microbiological identification, and targeted intraperitoneal and systemic antibiotic treatment, along with catheter management, are crucial in achieving a favorable outcome in such cases.
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Affiliation(s)
- Ibrahim Tawhari
- King Khalid University, Abha, Saudi Arabia
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Samantha Saggese
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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17
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Dreznik Y, Paran M, Bilavsky E, Avinadav E, Kravarusic D. Antibiotic Treatment in Complicated Appendicitis: Can It Be Optimized? Isr Med Assoc J 2024; 26:30-33. [PMID: 38420639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND The management of complicated appendicitis is inconclusive. Guidelines have not been established for the use of personalized antibiotic treatment. OBJECTIVES To investigate specific risk factors to consider during the initial first-choice antibiotic therapy in children with complicated appendicitis. METHODS This study included all pediatric patients younger than 18 years of age who underwent a laparoscopic appendectomy during 2012-2022 at a single tertiary medical center. RESULTS In total, 300 pediatric patients underwent laparoscopic appendectomy due to complicated appendicitis. The patients were treated with ceftriaxone + metronidazole (CM). For 57 (19%) patients, the empirical treatment was changed to tazobactam/piperacillin (TP) due to resistant bacteria or clinical deterioration. The presence of generalized peritonitis during surgery and C-reactive protein (CRP) levels above 20 mg/L at admission were identified as risk factors for changing the antibiotic regimen from CM to TP. CONCLUSIONS Generalized peritonitis and CRP > 20 gr/L were highly correlated with changing the antibiotic regimen to TP. For such patients, initial treatment with TP may result in clinical improvement and shorter hospitalization.
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Affiliation(s)
- Yael Dreznik
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center, Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Paran
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center, Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efraim Bilavsky
- Department of Pediatrics C, Schneider Children's Medical Center, Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Avinadav
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center, Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dragan Kravarusic
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center, Petah Tikva, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Low EXS, Wang YP, Lu CL. Risks of Proton Pump Inhibitors in Patients with Cirrhosis: Please Peruse the Indications. Dig Dis Sci 2024; 69:7-9. [PMID: 37968555 DOI: 10.1007/s10620-023-08153-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 11/17/2023]
Abstract
The use of proton pump inhibitor (PPI) in cirrhotic patients can be associated with increased risks of long-term mortality, decompensation, hepatic encephalopathy, spontaneous bacterial peritonitis, and infection, but not with short-term mortality. Ensure clear indications at lowest effective dose of is mandatory for the use of PPI among cirrhotic patients.
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Affiliation(s)
- En Xian Sarah Low
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Po Wang
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Liang Lu
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
- Institute of Brain Science, National Yang Ming Chiao Tung Univeristy, Taipei, Taiwan.
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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19
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Wong ZY, Koh JH, Muthiah M, Koh B, Ong EYH, Ong CEY, Ou KQ, Lim WH, Tan DJH, Chee D, Siah KTH, Wong Y, Kaewdech A, Wijarnpreecha K, Kulkarni AV, Nah B, Huang DQ, Noureddin M, Ng CH, Teng M. Proton Pump Inhibitors Increases Longitudinal Risk of Mortality, Decompensation, and Infection in Cirrhosis: A Meta-Analysis. Dig Dis Sci 2024; 69:289-297. [PMID: 37968557 DOI: 10.1007/s10620-023-08150-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/09/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND/AIMS Proton pump inhibitors (PPIs) are frequently prescribed to cirrhotic patients, but there is limited longitudinal evidence regarding their effects. This study aimed to assess the impact of PPIs on adverse events in cirrhotic patients. METHODS A comprehensive search was conducted using the Medline and Embase databases to identify relevant articles. Pooled hazard ratios (HRs) using DerSimonian and Laird random-effects model were calculated to evaluate the risk of adverse events such as long-term mortality, hepatic decompensation, hepatic encephalopathy (HE), spontaneous bacterial peritonitis (SBP), and overall infection in cirrhotic patients with PPI use. RESULTS The analysis included 28 studies with 260,854 cirrhotic patients. The prevalence of PPI use among cirrhotic patients was 55.93%. The use of PPIs was not significantly associated with short-term mortality in cirrhotic patients. However, long-term mortality (HR 1.321, 95% CI 1.103-1.581, P = 0.002), decompensation (HR 1.646, 95% CI 1.477-1.835, P < 0.001), HE (HR 1.968, 95% CI 1.372-2.822, P < 0.001), SBP (HR 1.751, 95% CI 1.649-1.859, P < 0.001), and infection (HR 1.370, 95% CI 1.148-1.634, P < 0.001) were significantly associated with PPI use. Sensitivity analysis with prospective studies yielded similar results. CONCLUSION PPIs should be reserved for appropriate indications at lowest effective dose for cirrhotic patients due to the potential harm.
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Affiliation(s)
- Zhen Yu Wong
- Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jia Hong Koh
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Benjamin Koh
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Elden Yen Hng Ong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Christen En Ya Ong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Kai Qi Ou
- Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Douglas Chee
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Yujun Wong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Apichat Kaewdech
- Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Anand V Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Benjamin Nah
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
- Division of Gastroenterology, NAFLD Research Center, University of California at San Diego, La Jolla, CA, USA
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | | | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore.
| | - Margaret Teng
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
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Thammavaranucupt K, Pichitporn W, Parapiboon W, Wongluechai L, Kirdlarp S, Kanjanabuch T. Intraluminal catheter colonisation: A clue for establishing the microbiologic diagnosis of peritoneal dialysis-related fungal peritonitis. Perit Dial Int 2024; 44:78-80. [PMID: 37691426 DOI: 10.1177/08968608231196035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Affiliation(s)
- Kanin Thammavaranucupt
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | | | | | | | - Suppachok Kirdlarp
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Talerngsak Kanjanabuch
- Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- CAPD Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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21
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Huang Y, Xia L, Shen W, Fu T. A case report: Infection-related glomerulonephritis and mantle cell lymphoma due to mycobacterium avium complex infection. Medicine (Baltimore) 2023; 102:e35620. [PMID: 38206690 PMCID: PMC10754588 DOI: 10.1097/md.0000000000035620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/20/2023] [Indexed: 01/13/2024] Open
Abstract
RATIONALE Mycobacterium avium complex (MAC) infection is common in lung, liver and skin. However, MAC presenting with peritonitis is uncommon and is particularly rare in immunocompetent patients. We report a case of infection-associated glomerulonephritis and mantle cell lymphoma caused by peritonitis due to MAC. PATIENT CONCERNS We report a case of a 73-year-old elderly man with fever and abdominal pain for 2 days and gradually developed anuria, ascites, and abdominal lymphadenopathy. DIAGNOSES The initial diagnosis was peritonitis and acute renal failure. There was no significant relief of symptoms after empirical anti-infective therapy and hemodialysis. infection-associated glomerulonephritis, mantle cell lymphoma, and peritonitis due to MAC were diagnosed by renal biopsy, abdominal lymph node biopsy, and metagenomics next-generation sequencing. INTERVENTIONS The patient received empirical antibiotic therapy, hemodialysis, and anti-MAC therapy. OUTCOMES Unfortunately, the patient eventually died of septic shock after the 21st day of admissiom. LESSONS Early diagnosis of MAC infection is essential. When the cause of fever is unknown, metagenomics next-generation sequencing can be considered.
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Affiliation(s)
- Yiqi Huang
- Department of Nephrology, Shaoxing Second Hospital, Shaoxing, Zhejiang, China
| | - Li Xia
- Department of Nephrology, Shaoxing Second Hospital, Shaoxing, Zhejiang, China
| | - Weigang Shen
- Department of Nephrology, Shaoxing Second Hospital, Shaoxing, Zhejiang, China
| | - Tianxiao Fu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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22
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Mangal S, Ranot N, Nosran A, Singh V, Chhibber S, Harjai K. In vivo efficacy of pyochelin-mediated delivery of zingerone in Pseudomonas aeruginosa-induced peritonitis. Future Microbiol 2023; 18:1339-1351. [PMID: 37962488 DOI: 10.2217/fmb-2023-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
Aim: The efficacy of a pyochelin-zingerone conjugate (PZC) against Pseudomonas aeruginosa in vivo in a mouse model of peritonitis, as well as mode of action in vitro, were investigated. Methods & results: Intraperitoneal administration of PZC (220 mg kg-1 b.wt.) resulted in a significant reduction in bacterial count in liver tissue by 2 log10 on the 4th day post infection. This was supported by reduced levels of inflammatory markers, liver function, inflammatory cytokines and improved histopathology. PZC showed its ability to disrupt the cellular membrane, increase permeability of the membrane and leakage of intracellular contents of P. aeruginosa, resulting in its death. Conclusion: The present study reports the hepatoprotective potential of PZC in an experimental model of P. aeruginosa-induced peritonitis.
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Affiliation(s)
- Surabhi Mangal
- Department of Microbiology, Panjab University, Chandigarh, 160025, India
| | - Nishma Ranot
- Department of Microbiology, Panjab University, Chandigarh, 160025, India
| | - Anu Nosran
- Department of Microbiology, Panjab University, Chandigarh, 160025, India
| | - Vasundhara Singh
- Department of Applied Sciences, Punjab Engineering College (Deemed to be University), Chandigarh, 160012, India
| | - Sanjay Chhibber
- Department of Microbiology, Panjab University, Chandigarh, 160025, India
| | - Kusum Harjai
- Department of Microbiology, Panjab University, Chandigarh, 160025, India
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Mohammed Abdul MK, Osman KT, Cappuccio JM, Spencer C, Satapathy SK. Nosocomial spontaneous bacterial peritonitis is associated with high mortality - a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2023; 17:1333-1339. [PMID: 37982715 DOI: 10.1080/17474124.2023.2284825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION It is unclear if Nosocomial Spontaneous Bacteria Peritonitis (NSBP) is associated with higher mortality compared with community acquired spontaneous bacterial peritonitis. METHODS Database search from inception to May 2022 was conducted. The databases included MEDLINE, EMBASE, Cochrane registry of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus. Inclusion criteria were as follows: adult patients, age >18 years, with a diagnosis of NSBP. Pooled estimates of mortality were calculated following the restricted maximum likelihood method. The mortality rate between NSBP and CA-SBP was reported as odds ratio (OR) and 95% confidence interval (CI). Data synthesis was obtained using random effects meta-analysis. Heterogeneity was reported as I2. RESULTS A total of 482 unique titles were screened. Twenty-two articles were included. A total of 2,145 patients with NSBP were included. Patients were followed for a median of 90 days. The pooled mortality rate of NSBP was 52.51% (95% CI 42.77-62.06%; I2 83.72%). Seven studies compared the mortality outcome of patients with NSBP and CA-SBP. NSBP was significantly associated with a higher rate of mortality (OR 2.78, 95% CI 1.87-4.11; I2 36.00%). CONCLUSION NSBP was associated with higher mortality rate compared to CA-SBP, which could be due to a higher rate of resistance organisms.
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Affiliation(s)
| | - Karim T Osman
- Department of Internal Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Joseph M Cappuccio
- Department of Internal Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Carol Spencer
- Department of Library Services, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Sanjaya K Satapathy
- Sandra Atlas Bass Center for Liver Diseases and Transplantation, Manhasset, NY, USA
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Zhuang Z, Li Y, Wu X, Wang W, Cao M, Xiao N. Successful treatment of peritonitis caused by Acremonium species without catheter removal: Case report and literature review. J Infect Dev Ctries 2023; 17:1631-1635. [PMID: 38064384 DOI: 10.3855/jidc.17679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/25/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION It is a rare case of continuous ambulatory peritoneal dialysis-related peritonitis associated with Acremonium spp infection. CASE PRESENTATION Symptoms of Acremonium infection peritonitis are hidden and atypical, leucocytes in ascites are moderately elevated, and general bacterial culture difficulty obtains positive results. In this report, a patient with peritoneal dialysis-related peritonitis caused by Acremonium species was successfully treated without catheter removal in our hospital. The organism species was cultured from a catheter and PD effluent fluid. The patient's peritonitis did not relapse within 6 months. CONCLUSIONS Once a patient on peritoneal dialysis was infected with fungal peritonitis, the outcome was usually to remove the tube and stop peritoneal dialysis. In this case, our experience is that using a catheter-salvage therapy method, we can successfully cure PD-related peritonitis associated with Acremonium sp.
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Affiliation(s)
- Zhen Zhuang
- Department of Nephrology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yuehong Li
- Department of Nephrology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xianglan Wu
- Department of Nephrology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wei Wang
- Department of Nephrology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Mingxia Cao
- Department of Nephrology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Nan Xiao
- Laboratory Medicine Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Du T, Li QP, Jiang GX, Tan HY, Wu JH, Qin SY, Yu B, Jiang HX, Luo W. Systematically analysis of decompensated cirrhotic patients with spontaneous bacterial peritonitis to identify diagnostic and prognostic indexes. BMC Infect Dis 2023; 23:786. [PMID: 37951894 PMCID: PMC10640738 DOI: 10.1186/s12879-023-08731-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Spontaneous bacterial peritonitis (SBP) is a common complication in patients with cirrhosis. The diagnosis of SBP is still mostly based on ascites cultures and absolute ascites polymorphonuclear (PMN) cell count, which restricts the widely application in clinical settings. This study aimed to identify reliable and easy-to-use biomarkers for both diagnosis and prognosis of cirrhotic patients with SBP. METHODS We conducted a retrospective study including 413 cirrhotic patients from March 2013 to July 2022 in the First Affiliated Hospital of Guangxi Medical University. Patients' clinical characteristics and laboratory indices were collected and analyzed. Two machine learning methods (Xgboost and LASSO algorithms) and a logistic regression analysis were adopted to screen and validate the indices associated with the risk of SBP. A predictive model was constructed and validated using the estimated area under curve (AUC). The indices related to the survival of cirrhotic patients were also analyzed. RESULTS A total of 413 cirrhotic patients were enrolled in the study, of whom 329 were decompensated and 84 were compensated. 52 patients complicated and patients with SBP had a poorer Child-Pugh score (P < 0.05). Patients with SBP had a greater proportion of malignancies than those without SBP(P < 0.05). The majority of laboratory test indicators differed significantly between patients with and without SBP (P < 0.05). Albumin, neutrophil-to-lymphocyte ratio (NLR), and ferritin-to-neutrophil ratio (FNR) were found to be independently associated with SBP in decompensated cirrhotic patients using LASSO algorithms, and logistic regression analysis. The model established by the three indices showed a high predictive value with an AUC of 0.808. Furthermore, increased neutrophils, ALP, and C-reactive protein-to-albumin ratio (CAR) were associated with the shorter survival time of patients with decompensated cirrhosis, and the combination of these indices showed a greater predictive value for cirrhotic patients. CONCLUSIONS The present study identified FNR as a novel index in the diagnosis of SBP in decompensated patients with cirrhosis. A model based on neutrophils, ALP and CAR showed high performance in predicting the prognosis of patients with decompensated cirrhosis.
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Affiliation(s)
- Tao Du
- Department of Gastroenterology, the First Affiliated Hospital of Guangxi Medical University, No. 6, Shuangyong Road, Nanning, 530021, China
| | - Qing-Ping Li
- Department of Gastroenterology, the First Affiliated Hospital of Guangxi Medical University, No. 6, Shuangyong Road, Nanning, 530021, China
| | - Gui-Xiang Jiang
- Department of Gastroenterology, the First Affiliated Hospital of Guangxi Medical University, No. 6, Shuangyong Road, Nanning, 530021, China
| | - Hui-Yuan Tan
- Department of Gastroenterology, the First Affiliated Hospital of Guangxi Medical University, No. 6, Shuangyong Road, Nanning, 530021, China
| | - Jiao-Hua Wu
- Department of Gastroenterology, the First Affiliated Hospital of Guangxi Medical University, No. 6, Shuangyong Road, Nanning, 530021, China
| | - Shan-Yu Qin
- Department of Gastroenterology, the First Affiliated Hospital of Guangxi Medical University, No. 6, Shuangyong Road, Nanning, 530021, China
| | - Bing Yu
- Department of Gastroenterology, the Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hai-Xing Jiang
- Department of Gastroenterology, the First Affiliated Hospital of Guangxi Medical University, No. 6, Shuangyong Road, Nanning, 530021, China.
| | - Wei Luo
- Department of Gastroenterology, the First Affiliated Hospital of Guangxi Medical University, No. 6, Shuangyong Road, Nanning, 530021, China.
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Makabenta JMV, Nabawy A, Chattopadhyay AN, Park J, Li CH, Goswami R, Luther DC, Huang R, Hassan MA, Rotello VM. Antimicrobial-loaded biodegradable nanoemulsions for efficient clearance of intracellular pathogens in bacterial peritonitis. Biomaterials 2023; 302:122344. [PMID: 37857021 PMCID: PMC10872928 DOI: 10.1016/j.biomaterials.2023.122344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023]
Abstract
Intracellular pathogenic bacteria use immune cells as hosts for bacterial replication and reinfection, leading to challenging systemic infections including peritonitis. The spread of multidrug-resistant (MDR) bacteria and the added barrier presented by host cell internalization limit the efficacy of standard antibiotic therapies for treating intracellular infections. We present a non-antibiotic strategy to treat intracellular infections. Antimicrobial phytochemicals were stabilized and delivered by polymer-stabilized biodegradable nanoemulsions (BNEs). BNEs were fabricated using different phytochemicals, with eugenol-loaded BNEs (E-BNEs) affording the best combination of antimicrobial efficacy, macrophage accumulation, and biocompatibility. The positively-charged polymer groups of the E-BNEs bind to the cell surface of macrophages, facilitating the entry of eugenol that then kills the intracellular bacteria without harming the host cells. Confocal imaging and flow cytometry confirmed that this entry occurred mainly via cholesterol-dependent membrane fusion. As eugenol co-localized and interacted with intracellular bacteria, antibacterial efficacy was maintained. E-BNEs reversed the immunosuppressive effects of MRSA on macrophages. Notably, E-BNEs did not elicit resistance selection after multiple exposures of MRSA to sub-therapeutic doses. The E-BNEs were highly effective against a murine model of MRSA-induced peritonitis with better bacterial clearance (99 % bacteria reduction) compared to clinically-employed treatment with vancomycin. Overall, these findings demonstrate the potential of E-BNEs in treating peritonitis and other refractory intracellular infections.
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Affiliation(s)
- Jessa Marie V Makabenta
- Department of Chemistry, University of Massachusetts Amherst, 710 North Pleasant Street, Amherst, MA, 01003, United States
| | - Ahmed Nabawy
- Department of Chemistry, University of Massachusetts Amherst, 710 North Pleasant Street, Amherst, MA, 01003, United States
| | - Aritra Nath Chattopadhyay
- Department of Chemistry, University of Massachusetts Amherst, 710 North Pleasant Street, Amherst, MA, 01003, United States
| | - Jungmi Park
- Department of Chemistry, University of Massachusetts Amherst, 710 North Pleasant Street, Amherst, MA, 01003, United States
| | - Cheng-Hsuan Li
- Department of Chemistry, University of Massachusetts Amherst, 710 North Pleasant Street, Amherst, MA, 01003, United States
| | - Ritabrita Goswami
- Department of Chemistry, University of Massachusetts Amherst, 710 North Pleasant Street, Amherst, MA, 01003, United States
| | - David C Luther
- Department of Chemistry, University of Massachusetts Amherst, 710 North Pleasant Street, Amherst, MA, 01003, United States
| | - Rui Huang
- Department of Chemistry, University of Massachusetts Amherst, 710 North Pleasant Street, Amherst, MA, 01003, United States
| | - Muhammad Aamir Hassan
- Department of Chemistry, University of Massachusetts Amherst, 710 North Pleasant Street, Amherst, MA, 01003, United States
| | - Vincent M Rotello
- Department of Chemistry, University of Massachusetts Amherst, 710 North Pleasant Street, Amherst, MA, 01003, United States.
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Islam S, Ghosh CK, Hamid R, Parvin S, Chowdhury FK, Kabir A, Miah AR. Association of serum sodium and 24-hour urinary sodium level with the severity and complications of ascites in cirrhotic patients. Medicine (Baltimore) 2023; 102:e35596. [PMID: 37904436 PMCID: PMC10615426 DOI: 10.1097/md.0000000000035596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 09/20/2023] [Indexed: 11/01/2023] Open
Abstract
Hyponatremia is an independent predictor of mortality in cirrhotic patients but little is known regarding the relationship between the level of serum sodium and 24-hour urinary sodium with the development of severity and complications of cirrhotic ascites. To observe the association of serum sodium and 24-hour urinary sodium levels with different grades of ascites and its complications in cirrhotic patients. In the department of Gastroenterology in a tertiary care hospital, this cross-sectional study was conducted from April 2019 to September 2020. A total of 96 admitted cirrhotic patients with ascites were enrolled in this study by consecutive sampling. Out of 96 patients with cirrhotic ascites, 48 patients had mild, moderate, and severe ascites and 48 patients had complications of ascites like refractory ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome. The mean serum sodium level was 131.69 ± 4.90 and 124.88 ± 5.67 mmol/L and the 24-hour urinary sodium level was 76.82 ± 45.64 and 35.26 ± 22.57 mmol/L in uncomplicated and complicated ascites groups respectively with P value < .001. In grade 1, grade 2, and grade 3 ascites, there was a significant (P = .001), association between mean serum sodium (mmol/L) level (R -0.777) and 24-hour urine sodium (mmol/L) level (R -0.704) but no significant difference was seen when refractory ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome were considered. In our finding, low serum sodium and low 24-hour urinary sodium levels were associated with the development of severe complications of cirrhotic ascites. Hence, Serum sodium and 24-hour urinary sodium levels can be good predictors of grading and complications of cirrhotic ascites.
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Affiliation(s)
- Susmita Islam
- Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Chanchal Kumar Ghosh
- Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Rayhan Hamid
- National Institute of Traumatology and orthopedic rehabilitation, (NITOR) Dhaka, Bangladesh
| | - Sultana Parvin
- Department of Medical Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Mohakhali, Dhaka, Bangladesh
| | - Fazlul Karim Chowdhury
- Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Anwarul Kabir
- Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Abdur Rahim Miah
- Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
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Datta IK, Bhuiyan TM. Significance of Serum Procalcitonin and C-Reactive Protein in the Diagnosis and Prediction of Spontaneous Bacterial Peritonitis in Decompensated Chronic Liver Disease. Mymensingh Med J 2023; 32:1163-1168. [PMID: 37777916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
The role of serum procalcitonin (PCT) and C-reactive protein (CRP) levels in the diagnosis of spontaneous bacterial peritonitis (SBP) with decompensated chronic liver disease (CLD) has been a subject of debate. The purpose of this cross-sectional, observational study was to evaluate the significance of CRP and PCT for the diagnosis and prediction of SBP in decompensated CLD patients. Fifty patients with ascites due to decompensated CLD were enrolled conveniently from the department of Gastrointestinal, Hepatobiliary and Pancreatic disorders (GHPD), BIRDEM General Hospital, Bangladesh from July 2019 to July 2020. Of these decompensated CLD patients with SBP were enrolled as the case group and without SBP as control group. Diagnostic and predictive value of PCT and CRP were calculated using the different statistical analysis. Among 50 patients, SBP was diagnosed in 9 patients (18.0%). The ROC analysis results yielded that the optimum cut off value for PCT was 0.67ng/ml and sensitivity, specificity, positive predictive value, negative predictive value, accuracy, AUC were 88.9%, 90.2%, 66.6%, 97.3, 90%, 0.947 respectively. On the contrary the optimum cut off value for CRP was 57.4mg/L and sensitivity, specificity, positive predictive value, negative predictive value, accuracy, AUC were 77.8%, 85.4%, 53.8%, 94.5%, 84%, 0.859 respectively. Our results indicate that the value of serum PCT and CRP were reliable to diagnose SBP in ascites due to decompensated CLD. Serum PCT and CRP level measurements may provide an early good diagnostic test for SBP in decompensated CLD patients.
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Affiliation(s)
- I K Datta
- Dr Indrajit Kumar Datta. Associate Professor, Department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders, BIRDEM General Hospital, Dhaka, Bangladesh; E-mail: E-mail:
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Huang YJ, Xiong LP, Zhang X, Zhou JF, Zhang R. Higher D-dimer and activated partial thromboplastin time are poor prognostic factors in patients with peritoneal dialysis-related peritonitis. Ther Apher Dial 2023; 27:918-925. [PMID: 37357362 DOI: 10.1111/1744-9987.14027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Coagulation system dysfunction is associated with adverse outcomes of peritoneal dialysis (PD) and bacterial infection. We investigated the association between coagulation system and treatment failure of peritoneal dialysis-related peritonitis (PDRP). METHODS We collected records of patients aged ≥18 years with PDRP. PDRP episodes were divided into: shortened activated partial thromboplastin time (APTT) group and prolonged APTT group, low D-dimer (DD) group and high DD group. The baseline characteristics of the groups were collected and compared. The association between APTT, DD and treatment failure of PDRP was analyzed using logistic regression analysis. RESULTS Thirty episodes of treatment failure were observed in 110 episodes of PDRP in our study. After adjusting for variables, prolonged APTT (OR = 1.166 [1.049-1.296], p = 0.004) or high level of DD (OR = 1.374 [1.057-1.787], p = 0.017) was associated with treatment failure of PDRP. CONCLUSION Prolonged baseline APTT or high level of DD increased the risk of treatment failure of PDRP.
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Affiliation(s)
- Ya-Juan Huang
- Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li-Ping Xiong
- Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xing Zhang
- Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jia-Fan Zhou
- Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Zhang
- Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Lei Y, Guo Q, Liu J, Huang H, Han P. Staphylococcus cohnii infection diagnosed by metagenomic next generation sequencing in a patient on hemodialysis with cirrhotic ascites: a case report. Front Cell Infect Microbiol 2023; 13:1240283. [PMID: 37808911 PMCID: PMC10556727 DOI: 10.3389/fcimb.2023.1240283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background Patients with spontaneous bacterial peritonitis (SBP) often just receive empirical antibiotic therapy, as pathogens can be identified in only few patients using the techniques of conventional culture. Metagenomic next generation sequencing (mNGS) is a useful tool for diagnosis of infectious diseases. However, clinical application of mNGS in diagnosis of infected ascites of cirrhotic patients is rarely reported. Case presentation A 53-year-old male with cirrhosis on regular hemodialysis presented with continuous abdominal pain. After treatment with empiric antibiotics, his inflammatory parameters decreased without significant relief of abdominal pain. Finally, based on ascites mNGS detection, he was diagnosed as infection of Staphylococcus cohnii (S.cohnii), a gram-positive opportunistic pathogen. With targeted antibiotic treatment, the bacterial peritonitis was greatly improved and the patient's abdominal pain was significantly alleviated. Conclusions When conventional laboratory diagnostic methods and empirical antibiotic therapy fail, proper application of mNGS can help identify pathogens and significantly improve prognosis and patients' symptoms.
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Affiliation(s)
| | | | | | - Huanjun Huang
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ping Han
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Dawit L, Lee V, Lehoang D, Furey C, Chowdhury A, Mai TA, Angajala V, Park JH, Khadarian K, She R, Vergara-Lluri M, Kahn J, Dodge JL, Saito T. Clinical Significance of Ascitic Fluid Polymorphonuclear Leukocyte Percentage in Patients With Cirrhosis Without Spontaneous Bacterial Peritonitis. Clin Transl Gastroenterol 2023; 14:e00614. [PMID: 37436155 PMCID: PMC10522094 DOI: 10.14309/ctg.0000000000000614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/10/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION Absolute polymorphonuclear leukocyte (PMN) count (PMN-C) ≥250 cells/mm 3 in ascites is the diagnostic hallmark of spontaneous bacterial peritonitis (SBP) and is associated with high morbidity and mortality. However, the clinical significance of ascitic PMN percentage (PMN-%) and PMN-C in the absence of SBP as additional biomarkers for mortality and future incidence of SBP has not been determined. METHODS This retrospective cohort included adults with cirrhosis undergoing first-recorded paracentesis with initial PMN-C < 250 cells/mm 3 at 2 tertiary medical centers between 2015 and 2020. Patients with prior SBP were excluded. Outcomes were death and SBP development. Cox regression estimated hazard ratios (HRs) for risk of death and SBP development and Akaike information criterion to compare model fit. RESULTS Three hundred eighty-four adults (73% male, median age 58 years, 67% with alcohol-associated cirrhosis, median PMN-C 14 cells/mm 3 [interquartile range 5-34], and median PMN-% 10% [interquartile range 4-20]) were included in this study. Univariate risk of death increased 10% per 25-unit increase in PMN-C (95% confidence interval 1.01-1.21, P = 0.03) and 19% per 10-unit increase in PMN-% (95% confidence interval 1.06-1.33, P = 0.003) with PMN-% demonstrating better model fit in assessing mortality risk (Akaike information criterion: 1,044 vs 1,048, respectively). In models adjusted for age, chronic hepatitis C virus infection, and Model for End-Stage Liver Disease-Sodium, PMN-% was associated with risk of death (PMN-% 10%-29%, HR 1.17, P = 0.50; PMN-% ≥ 30% group, HR 1.94, P = 0.03; vs PMN-% < 10%) and SBP development (PMN-% 10%-29%, HR 1.68, P = 0.07; PMN-% ≥ 30%, HR 3.48, P < 0.001; vs PMN-% < 10%). DISCUSSION Our results suggest PMN-% at first paracentesis represents a better biomarker compared with PMN-C for assessing risk of death and future SBP development in patients with PMN-C < 250 cells/mm 3 .
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Affiliation(s)
- Lillian Dawit
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Vivian Lee
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - David Lehoang
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Cameron Furey
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Aneesa Chowdhury
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Thu Anne Mai
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Varun Angajala
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Joo Hye Park
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kevork Khadarian
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Rosemary She
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Maria Vergara-Lluri
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jeffrey Kahn
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jennifer L. Dodge
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- USC Research Center for Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Takeshi Saito
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- USC Research Center for Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Gangwani MK, Aziz A, Priyanka F, Lee Smith W, Aziz M, Hassan M. Optimizing Antibiotic Duration for Spontaneous Bacterial Peritonitis Prophylaxis: Time to Rethink. Am J Ther 2023; 30:e492-e494. [PMID: 37713708 DOI: 10.1097/mjt.0000000000001570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Manesh K Gangwani
- Department of Medicine, University of Toledo Medical Center, Toledo, OH
| | - Abeer Aziz
- Department of Medicine, Aga Khan University, Karachi, Sindh, Pakistan
| | - Fnu Priyanka
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto University, Larkana, Pakistan
| | - Wade Lee Smith
- University of Toledo Libraries, University of Toledo, Toledo, OH
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH
| | - Mona Hassan
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH
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Chinese Society of Hepatology, Chinese Medical Association. [Guidelines on the management of ascites in cirrhosis (2023 version)]. Zhonghua Gan Zang Bing Za Zhi 2023; 31:813-26. [PMID: 37723063 DOI: 10.3760/cma.j.cn501113-20230719-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Chinese Society of Hepatology of Chinese Medical Association organized relevant experts to update the Guidelines on the management of ascites and complications in cirrhosis in 2017 and renamed it as Guidelines on the management of ascites in cirrhosis. It provides guiding recommendations for the diagnosis and treatment of cirrhotic ascites, spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS).
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Kar PS, Venishetty S, Laroia ST, Jindal A, Maiwall R, Sood AK, Shasthry SM, Rajan V, Arora V, Bhardwaj A, Kumar G, Kumar M. Tolerance of standard dose albumin infused over 6 hrs for treatment of spontaneous bacterial peritonitis-A randomized controlled trial. Indian J Gastroenterol 2023; 42:505-516. [PMID: 37422602 DOI: 10.1007/s12664-023-01389-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 04/27/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND AND AIMS Twenty per cent albumin (1.5 g/kg at diagnosis and 1 g/kg on day three, infused over six-hour duration) is recommended particularly in high-risk spontaneous bacterial peritonitis (SBP). Whether reduced dose albumin infusion is as effective as the standard dose albumin infusion is not clear. The aim of this study was to compare standard dose albumin infusion with reduced dose albumin infusion in acute kidney injury (AKI) development or progression in patients with cirrhosis and high-risk SBP. METHODS Sixty-three patients were randomized to the standard dose albumin arm (n = 31) and reduced dose albumin arm (n = 32, 0.75 g/kg at diagnosis and 0.5 g/kg 48 h later). The albumin was infused over six-hour duration in both groups. When the patient developed respiratory distress, the albumin infusion was stopped and that dose (i.e. of day one or day three) was not restarted and no attempt was made to finish the whole dose of that day. However, the next dose was started at the pre-calculated infusion rate if there was no evidence of respiratory distress at the start of next infusion. RESULTS All 31 patients in standard dose and two (6.25%) in the reduced dose group developed symptomatic circulatory overload (p < 0.001), with infusions being stopped prematurely. The actual albumin dose received on day one was similar in both groups and only slightly higher in the standard dose group on day three. Resolution of SBP, progression of AKI to higher stage, in-hospital mortality and 28 days' mortality were similar in both groups. CONCLUSIONS For treatment of SBP, standard dose albumin infusion (1.5 g/kg at diagnosis and 1 g/kg 48 hours later) infused over six hours is not tolerated by Indian patients. The effectiveness of standard dose albumin infused over more prolonged periods, as compared to reduced dose albumin, should be evaluated in further studies. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT04273373 .
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Affiliation(s)
- Pinakee Sunder Kar
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110 070, India
| | - Shantan Venishetty
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110 070, India
| | - Shalini Thapar Laroia
- Department of Radiology, Institute of Liver and Biliary Sciences, D 1 Vasant Kunj, New Delhi, 110 070, India
| | - Ankur Jindal
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110 070, India
| | - Rakhi Maiwall
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110 070, India
| | - Arun Kumar Sood
- Department of Cardiology, Institute of Liver and Biliary Sciences, D 1 Vasant Kunj, New Delhi, 110 070, India
| | - Saggere Muralikrishna Shasthry
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110 070, India
| | - Vijayaraghavan Rajan
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110 070, India
| | - Vinod Arora
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110 070, India
| | - Ankit Bhardwaj
- Department of Clinical Research, Institute of Liver and Biliary Sciences, D 1 Vasant Kunj, New Delhi, 110 070, India
| | - Guresh Kumar
- Department of Biostatistics, Institute of Liver and Biliary Sciences, D 1 Vasant Kunj, New Delhi, 110 070, India
| | - Manoj Kumar
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110 070, India.
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Silva LBB, Brunaldi MO, Martinez R, Costa JACD. Peritonitis caused by paracoccidioides spp. in a patient on continuous ambulatory peritoneal dialysis - A case report. Braz J Infect Dis 2023; 27:102792. [PMID: 37488046 PMCID: PMC10412859 DOI: 10.1016/j.bjid.2023.102792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
Paracoccidioidomycosis is a systemic mycosis found mainly in South America and is the most prevalent endemic and systemic mycosis in Brazil. The purpose of this paper was to report the case of a male patient who developed peritonitis caused by Paracoccidioides spp. Forty-eight-year-old, male patient, with type I Diabetes mellitus and chronic kidney disease who was undergoing a Continuous Ambulatory Peritoneal Dialysis (CAPD) program. After eighteen months of peritoneal dialysis, the patient developed turbidity of the peritoneal fluid and was diagnosed with peritonitis. Direct mycological examination of the peritoneal fluid revealed yeasts with morphology suggestive of Paracoccidioides spp. The patient was treated with sulfamethoxazole-trimethoprim (1,600 mg/320 mg dose/day) for 61 days, but he died because a bacterial septic shock. The diagnosis of opportunistic PCM peritonitis was later confirmed by autopsy and Paracoccidioides spp. isolation. This is the first reported case of a patient on CAPD who experienced complications due peritonitis caused by opportunistic PCM.
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Affiliation(s)
- Lázaro Bruno Borges Silva
- Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Divisão de Nefrologia, Ribeirão Preto, SP, Brazil
| | - Mariângela Ottoboni Brunaldi
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Patologia, Ribeirão Preto, SP, Brazil
| | - Roberto Martinez
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Divisão de Doenças Infecciosas e Tropicais, Ribeirão Preto, SP, Brazil
| | - José Abrão Cardeal da Costa
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Divisão de Nefrologia, Ribeirão Preto, SP, Brazil.
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Zheng X, Bai Z, Wang T, Romeiro FG, Mancuso A, Philips CA, Wong YJ, Nery FG, Qi X. Human Albumin Infusion for the Management of Liver Cirrhosis and Its Complications: An Overview of Major Findings from Meta-analyses. Adv Ther 2023; 40:1494-1529. [PMID: 36697778 DOI: 10.1007/s12325-023-02430-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The role of human albumin (HA) infusion in cirrhotic patients has been increasingly recognized. This paper aims to summarize the evidence from meta-analyses regarding HA infusion for the management of cirrhosis and its complications. METHODS A systematic search in the PubMed, EMBASE, and Cochrane library databases, and in reference lists was conducted. All relevant meta-analyses were identified and their findings were reviewed. The Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) checklist was used to evaluate the methodological quality and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system to assess the quality of evidence for significant outcomes. RESULTS Among 300 papers initially identified, 18 meta-analyses have been included. Short- and long-term HA infusion at high doses decreased the mortality of patients with decompensated cirrhosis. In cirrhotic patients with ascites, long-term HA infusion reduced the recurrence of ascites, but not mortality. In cirrhotic patients undergoing large-volume paracentesis (LVP), HA infusion reduced the incidence of post-paracentesis circulatory dysfunction and hyponatremia, but not mortality or renal impairment. In cirrhotic patients with overt hepatic encephalopathy (HE), HA infusion improved the severity of overt HE, but not overall mortality. In cirrhotic patients with spontaneous bacterial peritonitis (SBP), but not those with non-SBP infections, HA infusion reduced the mortality and renal impairment. In cirrhotic patients with type-1 hepatorenal syndrome (HRS), an increment of 100 g in cumulative HA dose increased 1.15-fold survival, but not HRS reversal. In these meta-analyses, the quality of methodology was low or critically low, and that of the evidence was from very low to moderate. CONCLUSIONS Based on the limited evidence from these meta-analyses, HA infusion appears to be beneficial in cirrhotic patients with ascites, overt HE, and SBP and in those undergoing LVP, but not in those with non-SBP infections.
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Affiliation(s)
- Xiaojie Zheng
- Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Zhaohui Bai
- Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning, China
- Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China
| | - Ting Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning, China
- Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China
| | - Fernando G Romeiro
- Internal Medicine Department, Botucatu Medical School, São Paulo, Brazil
| | - Andrea Mancuso
- Medicina Interna 1, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Cyriac A Philips
- Clinical and Translational Hepatology, The Liver Institute, Center of Excellence in GI Sciences, Rajagiri Hospital, Aluva, India
| | - Yu J Wong
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore
- Duke-NUS Medical School, SingHealth, Singapore, Singapore
| | - Filipe G Nery
- Serviço de Cuidados Intensivos, Unidade de Cuidados Intermédios Médico-Cirúrgica, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning, China.
- Postgraduate College, China Medical University, Shenyang, China.
- Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China.
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Marciano S, Gutierrez-Acevedo MN, Barbero S, Del C Notari L, Agozino M, Fernandez JL, Anders MM, Grigera N, Antinucci F, Orozco Ganem OF, Murga MD, Perez D, Palazzo A, Martinez Rejtman L, Duarte IG, Vorobioff J, Trevizan V, Bulaty S, Bessone F, Valverde M, Elizondo M, Bosia JD, Borzi SM, Stieben TE, Masola A, Ferretti SE, Arufe D, Demirdjian E, Raffa MP, Peralta M, Fainboim HA, Vazquez CE, Ruiz P, Martínez JE, Heffner LA, Odzak A, Dirchwolf M, Smud A, Mendizabal M, Bellizzi C, Martinez A, Tomatis J, Bruno A, Ramos A, Pages J, Tevez S, Gadano AC, Giunta DH. Norfloxacin prophylaxis effect on multidrug resistance in patients with cirrhosis and bacterial infections. Eur J Clin Microbiol Infect Dis 2023; 42:481-491. [PMID: 36820931 DOI: 10.1007/s10096-023-04572-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
It is unclear whether norfloxacin predisposes to infections by multidrug-resistant organisms (MDROs). We aimed to evaluate if patients with cirrhosis receiving norfloxacin prophylaxis at the time of the diagnosis of bacterial infections were more likely to present a multidrug-resistant isolate than those without prophylaxis. This is a cross-sectional study of hospitalized patients with cirrhosis and bacterial infections from Argentina and Uruguay (NCT03919032) from September 2018 to December 2020. The outcome variable was a multidrug-resistant bacterial infection. We used inverse probability of treatment weighting to estimate the odds ratio (OR) of norfloxacin on infection caused by MDROs considering potential confounders. Among the 472 patients from 28 centers, 53 (11%) were receiving norfloxacin at the time of the bacterial infection. Patients receiving norfloxacin had higher MELD-sodium, were more likely to have ascites or encephalopathy, to receive rifaximin, beta-blockers, and proton-pump inhibitors, to have a nosocomial or health-care-associated infection, prior bacterial infections, admissions to critical care units or invasive procedures, and to be admitted in a liver transplant center. In addition, we found that 13 (24.5%) patients with norfloxacin and 90 (21.5%) of those not receiving it presented infections caused by MDROs (adjusted OR 1.55; 95% CI: 0.60-4.03; p = 0.360). The use of norfloxacin prophylaxis at the time of the diagnosis of bacterial infections was not associated with multidrug resistance. These results help empiric antibiotic selection and reassure the current indication of norfloxacin prophylaxis in well-selected patients.Study registration number: NCT03919032.
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Affiliation(s)
- Sebastián Marciano
- Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
- Department of Research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | | | - Sabrina Barbero
- Liver Unit, Hospital Churruca Visca, Buenos Aires, Argentina
| | | | | | | | | | - Nadia Grigera
- Liver Unit, Hospital Alemán, Buenos Aires, Argentina
| | | | | | - Maria D Murga
- Liver Unit, Hospital A.C. Padilla, San Miguel de Tucumán, Argentina
| | - Daniela Perez
- Liver Unit, Hospital A.C. Padilla, San Miguel de Tucumán, Argentina
| | - Ana Palazzo
- Liver Unit, Hospital A.C. Padilla, San Miguel de Tucumán, Argentina
| | | | - Ivonne G Duarte
- P. R. Liver Unit, Hospital 4 de Junio, Sáenz Peña, Argentina
| | - Julio Vorobioff
- Liver Unit, Hospital Provincial del Centenario, Rosario, Argentina
| | | | - Sofía Bulaty
- Liver Unit, Hospital Provincial del Centenario, Rosario, Argentina
| | - Fernando Bessone
- Liver Unit, Hospital Provincial del Centenario, Rosario, Argentina
| | - Marcelo Valverde
- Liver Unit, Unidad Bi-Institucional de Trasplante Hepatico, Hospital de Clínicas - Hospital Militar, Montevideo, Uruguay
| | - Martín Elizondo
- Liver Unit, Unidad Bi-Institucional de Trasplante Hepatico, Hospital de Clínicas - Hospital Militar, Montevideo, Uruguay
| | | | | | | | | | | | - Diego Arufe
- Liver Unit, Sanatorio Sagrado Corazón, Buenos Aires, Argentina
| | | | - Maria P Raffa
- Liver Unit, Sanatorio Sagrado Corazón, Buenos Aires, Argentina
| | | | | | - Cintia E Vazquez
- Liver Unit, Regional Hospital of Rio Gallegos, Rio Gallegos, Argentina
| | - Pablo Ruiz
- Liver Unit, Regional Hospital of Rio Gallegos, Rio Gallegos, Argentina
| | | | | | - Andrea Odzak
- Liver Unit, Hospital Argerich, Buenos Aires, Argentina
| | | | - Astrid Smud
- Infectious Diseases Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Ana Martinez
- Liver Unit, Hospital Fernández, Buenos Aires, Argentina
| | - Jesica Tomatis
- Liver Unit, Hospital Privado de Rosario, Rosario, Argentina
| | - Andres Bruno
- Liver Unit, Hospital Argerich, Buenos Aires, Argentina
| | - Agñel Ramos
- Liver Unit, Sanatorio Parque, Rosario, Argentina
| | - Josefina Pages
- Liver Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Silvina Tevez
- Liver Unit, Sanatorio Güemes, Buenos Aires, Argentina
| | - Adrian C Gadano
- Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Department of Research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Diego H Giunta
- Department of Research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Bhat C, Reinglas J, Costain N. Spontaneous bacterial peritonitis in cirrhosis. CMAJ 2023; 195:E120. [PMID: 36690370 PMCID: PMC9876590 DOI: 10.1503/cmaj.221090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Chirag Bhat
- Department of Emergency Medicine (Bhat, Costain), University of Ottawa, Ottawa, Ont.; Scarborough Health Network (Reinglas), Scarborough, Ont.
| | - Jason Reinglas
- Department of Emergency Medicine (Bhat, Costain), University of Ottawa, Ottawa, Ont.; Scarborough Health Network (Reinglas), Scarborough, Ont
| | - Nicholas Costain
- Department of Emergency Medicine (Bhat, Costain), University of Ottawa, Ottawa, Ont.; Scarborough Health Network (Reinglas), Scarborough, Ont
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Lin J, Lu Z, Li G, Zhang C, Lu H, Gao S, Zhu R, Huang H, Aden K, Wang J, Cong Y, Wu H, Liu Z. MCPIP-1-Mediated Immunosuppression of Neutrophils Exacerbates Acute Bacterial Peritonitis and Liver Injury. J Innate Immun 2022; 15:262-282. [PMID: 36273448 PMCID: PMC10643898 DOI: 10.1159/000526784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2023] Open
Abstract
Monocyte chemotactic protein-1-induced protein-1 (MCPIP-1) is highly expressed in activated immune cells and negatively regulates immune responses, while the mechanisms underlying the immunoregulation of neutrophils in acute bacterial infection and liver injury remain elusive. Here, we examined the role of MCPIP-1 in regulating neutrophil functions during acute bacterial peritonitis and liver injury. Mice with myeloid cell-specific overexpression (McpipMye-tg) or knockout (McpipΔMye) of MCPIP-1 were generated. We found that reactive oxygen species and myeloperoxidase production, formation of neutrophil extracellular traps, and migratory capacity were deficient in McpipMye-tg neutrophils but enhanced in McpipΔMye neutrophils. The recruitment of neutrophils and pathogen clearance were markedly suppressed in McpipMye-tg mice following intraperitoneal infection with Salmonella typhimurium while intensified in McpipΔMye mice. Severe acute S. typhimurium-infected peritonitis and liver injury occurred in McpipMye-tg mice but were alleviated in McpipΔMye mice. RNA sequencing, RNA-binding protein immunoprecipitation and qPCR analysis revealed that MCPIP-1 downregulated the protective functions of neutrophils via degrading the mRNA of cold inducible RNA-binding protein. Consistently, MCPIP-1 was highly expressed in neutrophils of patients with acute infectious diseases, especially in those with liver injury. Collectively, we uncover that MCPIP-1 negatively regulates the antibacterial capacities of neutrophils, leading to exacerbating severe acute bacterial peritonitis and liver injury. It may serve as a candidate target for maintaining neutrophil homeostasis to control acute infectious diseases.
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Affiliation(s)
- Jian Lin
- Department of Gastroenterology, Shanghai Tenth People's Hospital of Tongji University School of Medicine, Shanghai, China
- Department of Gastroenterology, Affiliated Hospital of Putian University, Putian, China
| | - Zhanjun Lu
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gengfeng Li
- Department of Gastroenterology, Shanghai Tenth People's Hospital of Tongji University School of Medicine, Shanghai, China
| | - Cui Zhang
- Department of Gastroenterology, Shanghai Tenth People's Hospital of Tongji University School of Medicine, Shanghai, China
| | - Huiying Lu
- Department of Gastroenterology, Shanghai Tenth People's Hospital of Tongji University School of Medicine, Shanghai, China
| | - Sheng Gao
- Department of Bioinformatics, School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Ruixin Zhu
- Department of Bioinformatics, School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Hailiang Huang
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Konrad Aden
- Department of Internal Medicine I, Institute of Clinical Molecular Biology, Christian-Albrechts-University, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jianhua Wang
- Storr Liver Unit, Westmead Millennium Institute, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Yingzi Cong
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Huili Wu
- Department of Gastroenterology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Zhanju Liu
- Department of Gastroenterology, Shanghai Tenth People's Hospital of Tongji University School of Medicine, Shanghai, China
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Zhu LC, Wu W, Zou B, Gan DK, Lin X, Zhou W, Xiong ML. Efficacy predictors of third-generation cephalosporins in treating spontaneous bacterial peritonitis. Medicine (Baltimore) 2022; 101:e30164. [PMID: 36221348 PMCID: PMC9542963 DOI: 10.1097/md.0000000000030164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Third-generation cephalosporins (3rd GCs) have recently become controversial as the first-line strategy for empirical spontaneous bacterial peritonitis (SBP) treatment. This study aimed to identify SBP treatment efficacy predictors of 3rd GCs. METHODS In this retrospective cohort study, 279 cirrhosis patients with SBP who received 3rd GC monotherapy for initial empirical treatment from 2013 to 2019 were included. Nonresponse was defined as a decreased ascites polymorphonuclear (PMN) count < 25% from baseline after 48 hours of antibacterial treatment. Multivariate regression analysis was used to identify efficacy predictors of 3rd GCs in treating SBP. Kaplan-Meier analysis was used to evaluate survival data. RESULTS The nonresponder group included 120 patients with no response, and the responder group included 159 patients with responses. The response rate to 3rd GCs was 57.0% among all patients. The common pathogens were Escherichia coli (40.6%), Staphylococcus (15.6%), Klebsiella pneumonia (12.5%), and Streptococcus (12.5%) in 32 ascites culture isolates. Nosocomial SBP (NSBP) (odds ratio [OR]: 2.371, 95% confidence interval [CI]: 1.323-4.249, P = .004), pneumonia (OR: 11.561, 95% CI: 1.876-71.257, P = .008), recurrent SBP (OR: 3.386, 95% CI: 1.804-6.357, P < .001), platelet count (≥113.5 × 109/L) (OR: 3.515, 95% CI: 1.973-6.263, P < .001), and ascites PMN count (≤0.760 × 109/L) (OR: 4.967, 95% CI: 2.553-9.663, P < .001) were independent predictors of nonresponse to 3rd GCs against SBP. Survival plot analysis at 30 days showed worse survival for the nonresponders (P = .003). CONCLUSION NSBP, pneumonia, recurrent SBP, increased platelet count, and lower ascites PMN count were independent predictors of nonresponse to 3rd GC in treating SBP. Nonresponse to initial antibiotic treatment was associated with worse survival.
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Affiliation(s)
- Long-Chuan Zhu
- Department of Liver Disease, The Ninth Hospital of Nanchang, Nanchang, Jiangxi, China
- *Correspondence: Long-Chuan Zhu, Department of Liver Disease, The Ninth Hospital of Nanchang, Nanchang, Jiangxi, 330002, China. (e-mail: )
| | - Wei Wu
- Department of Digestion, Children’s Hospital of Jiangxi Province, Nanchang, Jiangxi, China
| | - Bo Zou
- Department of Liver Disease, The Ninth Hospital of Nanchang, Nanchang, Jiangxi, China
| | - Da-Kai Gan
- Department of Liver Disease, The Ninth Hospital of Nanchang, Nanchang, Jiangxi, China
| | - Xue Lin
- Department of Liver Disease, The Ninth Hospital of Nanchang, Nanchang, Jiangxi, China
| | - Wei Zhou
- Department of Information Technology, The Ninth Hospital of Nanchang, Nanchang, Jiangxi, China
| | - Mo-Long Xiong
- Department of Liver Disease, The Ninth Hospital of Nanchang, Nanchang, Jiangxi, China
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de Mattos ÂZ, Simonetto DA, Terra C, Farias AQ, Bittencourt PL, Pase THS, Toazza MR, de Mattos AA. Albumin administration in patients with cirrhosis: Current role and novel perspectives. World J Gastroenterol 2022; 28:4773-4786. [PMID: 36156923 PMCID: PMC9476855 DOI: 10.3748/wjg.v28.i33.4773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/05/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
Mortality in cirrhosis is mostly associated with the development of clinical decompensation, characterized by ascites, hepatic encephalopathy, variceal bleeding, or jaundice. Therefore, it is important to prevent and manage such complications. Traditionally, the pathophysiology of decompensated cirrhosis was explained by the peripheral arterial vasodilation hypothesis, but it is currently understood that decompensation might also be driven by a systemic inflammatory state (the systemic inflammation hypothesis). Considering its oncotic and nononcotic properties, albumin has been thoroughly evaluated in the prevention and management of several of these decompensating events. There are formal evidence-based recommendations from international medical societies proposing that albumin be administered in individuals with cirrhosis undergoing large-volume paracentesis, patients with spontaneous bacterial peritonitis, those with acute kidney injury (even before the etiological diagnosis), and those with hepatorenal syndrome. Moreover, there are a few randomized controlled trials and meta-analyses suggesting a possible role for albumin infusion in patients with cirrhosis and ascites (long-term albumin administration), individuals with hepatic encephalopathy, and those with acute-on-chronic liver failure undergoing modest-volume paracentesis. Further studies are necessary to elucidate whether albumin administration also benefits patients with cirrhosis and other complications, such as individuals with extraperitoneal infections, those hospitalized with decompensated cirrhosis and hypoalbuminemia, and patients with hyponatremia.
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Affiliation(s)
- Ângelo Zambam de Mattos
- Graduate Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil
| | - Douglas Alano Simonetto
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55902, United States
| | - Carlos Terra
- Department of Gastroenterology, State University of Rio de Janeiro, Rio de Janeiro 20550-170, Brazil
| | | | | | - Tales Henrique Soares Pase
- Internal Medicine Unit, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
| | - Marlon Rubini Toazza
- Gastroenterology and Hepatology Unit, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
| | - Angelo Alves de Mattos
- Graduate Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil
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Jacobs L, Clevenbergh P, Collart F, Brayer I, Mesquita M, Taghavi M, Fosso C, Kaysi S, Nortier J, Dratwa M. Conséquences de la pandémie de COVID-19 sur le taux de péritonite de dialyse péritonéale : plaidoyer pour une formation continue ininterrompue. Nephrol Ther 2022; 18:526-533. [PMID: 36241606 PMCID: PMC9492510 DOI: 10.1016/j.nephro.2022.07.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/19/2022]
Abstract
Introduction La péritonite est une complication fréquente du traitement par dialyse péritonéale chronique, contribuant à l’échec de la technique et/ou au décès. Les avantages réels d’un programme de formation continue sur les taux de péritonites sont peu connus. Dans cette étude, nous avons mesuré l’influence du protocole de formation continue de nos patients sur le taux de péritonites. Nous avons également étudié les conséquences de la perturbation de notre protocole liée au Covid sur les taux de péritonites. Méthode Nous présentons nos taux annuels de péritonites depuis la mise en place de notre programme de formation continue des patients en 2010. Nous avons ensuite concentré notre étude sur trois années consécutives : 2019, 2020 (émergence de la COVID-19) et 2021, en recueillant les données microbiologiques de chaque épisode de péritonite. Des analyses statistiques ont été utilisées pour corroborer nos résultats. Résultats Depuis 2010, le taux de péritonites a diminué linéairement (R2 = 0,6556 ; df = 8 ; p < 0,01) jusqu’à son nadir en 2019 avec 4 épisodes de péritonites. La majorité des infections ont alors été traitées en ambulatoire. En 2020, notre évaluation continue des procédures de dialyse au domicile des patients a diminué de 51 % et 28 péritonites sont survenues, 47 % secondaires à des bactéries cutanées strictes, et 31 % gastro-intestinales, indépendamment de l’expérience des patients ou de la modalité de dialyse péritonéale. Le taux d’hospitalisations a atteint 71 %. Après avoir rétabli notre protocole, nous avons diminué le taux de péritonites de 50 % en 2021. Conclusions Les facteurs de risque de développer une péritonite sont identifiables et modifiables, et nécessitent des interventions soutenues, une surveillance visuelle ainsi qu’une formation continue. Ces interventions réduisent de manière significative les taux de péritonites. Toute brève interruption de l’évaluation de la technique des patients peut augmenter de manière significative les taux de péritonites.
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Affiliation(s)
- Lucas Jacobs
- Service de néphrologie et de dialyse, Centre hospitalier universitaire Brugmann, Université Libre de Bruxelles, Bruxelles, Belgique.
| | - Philippe Clevenbergh
- Clinique des maladies infectieuses, Département de médecine interne, Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Frédéric Collart
- Service de néphrologie et de dialyse, Centre hospitalier universitaire Brugmann, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Isabelle Brayer
- Service de néphrologie et de dialyse, Centre hospitalier universitaire Brugmann, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Maria Mesquita
- Service de néphrologie et de dialyse, Centre hospitalier universitaire Brugmann, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Maxime Taghavi
- Service de néphrologie et de dialyse, Centre hospitalier universitaire Brugmann, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Christelle Fosso
- Service de néphrologie et de dialyse, Centre hospitalier universitaire Brugmann, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Saleh Kaysi
- Service de néphrologie et de dialyse, Centre hospitalier universitaire Brugmann, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Joëlle Nortier
- Service de néphrologie et de dialyse, Centre hospitalier universitaire Brugmann, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Max Dratwa
- Service de néphrologie et de dialyse, Centre hospitalier universitaire Brugmann, Université Libre de Bruxelles, Bruxelles, Belgique
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Lichoska-Josifovikj F, Grivceva-Stardelova K, Todorovska B, Andreevski V, Nikolov F, Adem D. THE VALUE OF SERUM-ASCITES ALBUMIN GRADIENT AS A PREDICTOR OF SPONTANEOUS BACTERIAL PERITONITIS IN PATIENTS WITH LIVER CIRRHOSIS AND ASCITES. Georgian Med News 2022:23-25. [PMID: 36427835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Due to the high risk of adverse outcome, identifying predisposing factors for spontaneous bacterial peritonitis (SBP) is of paramount importance. Serum ascites albumin gradient (SAAG) has recently been included in the recommendations for the management of ascites in patients with cirrhosis by some associations. ; Aim - to determine the value of SAAG as a predictor of SBP and to compare the average values of SAAG in patients with SBP and non-SBP.; The study was designed as a prospective-analytical-observational and was conducted at the University Clinic for Gastroenterohepatology in Skopje in one-year period. The study population included 70 patients hospitalized patients with established liver cirrhosis, regardless of etiology They were divided into two groups, 35 patients with SBP and 35 non-SBP, with similar demographic characteristics as the SBP group with sterile ascites, in which all variables were examined as in the study group. The selection of patients who were included in the study was conducted according to predetermined inclusion and exclusion criteria.; The average value of SAAG in SBP was 19.0±4.6, and in non-SBP it was higher (23.2±5.5). The difference between the mean values was statistically significant for p<0.05 (t-test = 3.46512; p=0.000992). The univariate analysis of SAAG in prediction of SBP showed that SAAG <20 g/L significantly increased the chance of SBP by five times (Exp (B) = 5.337 (CI (1.976-15.516)).; Our analysis registered a statistically significant difference between the average values of SAAG in both groups. SAAG is a good predictor, significantly associated with the occurrence of SBP. Additional and extensive studies are necessary in order to confirm our conclusion in the future.
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Affiliation(s)
- F Lichoska-Josifovikj
- University Clinical Centre "Mother Teresa", Clinic of Gasteroenterohepatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R. North Macedonia
| | - K Grivceva-Stardelova
- University Clinical Centre "Mother Teresa", Clinic of Gasteroenterohepatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R. North Macedonia
| | - B Todorovska
- University Clinical Centre "Mother Teresa", Clinic of Gasteroenterohepatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R. North Macedonia
| | - V Andreevski
- University Clinical Centre "Mother Teresa", Clinic of Gasteroenterohepatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R. North Macedonia
| | - F Nikolov
- University Clinical Centre "Mother Teresa", Clinic of Gasteroenterohepatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R. North Macedonia
| | - D Adem
- University Clinical Centre "Mother Teresa", Clinic of Gasteroenterohepatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R. North Macedonia
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Wu HX, Hou W, Zhang W, Wang Z, Guo S, Chen DX, Li Z, Wei F, Hu Z. Clinical evaluation of bacterial DNA using an improved droplet digital PCR for spontaneous bacterial peritonitis diagnosis. Front Cell Infect Microbiol 2022; 12:876495. [PMID: 36061877 PMCID: PMC9433567 DOI: 10.3389/fcimb.2022.876495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Bacterial DNA (bactDNA) detection can be used to quickly identify pathogenic bacteria and has been studied on ascitic fluid. We aimed to retrospectively analyze the diagnostic value and applicational prospect of the bactDNA load in spontaneous bacterial peritonitis (SBP). Method We extracted viable bactDNA from ascitic samples of 250 patients with decompensated cirrhosis collected from October 2019 to April 2021 and detected the bactDNA by droplet digital polymerase chain reaction (ddPCR). We used ascitic samples of a baseline cohort of 191 patients to establish diagnostic thresholds for SBP and analyze the patients’ diagnostic performance based on ascites polymorphonuclear (PMN) and clinical manifestation. We performed bactDNA quantification analysis on 13 patients with a PMN less than 250 cells/mm3 but with clinical symptoms. The dynamic changes of the bactDNA load from eight patients (before, during, and after SBP) were analyzed. Results After the removal of free DNA, the bactDNA detected by ddPCR was generally decreased (1.75 vs. 1.5 log copies/µl, P < 0.001). Compared with the traditional culture and PMN count in the SBP diagnosis, the bactDNA showed that the ddPCR sensitivity was 80.5%, specificity was 95.3%, positive predictive value was 82.5%, and negative predictive value was 94.7%, based on clinical composite criteria. In patients with a PMN less than 250 cells/mm3, the bactDNA load of 13 patients with symptoms was significantly higher than those without symptoms (2.7 vs. 1.7 log copies/µl, P < 0.001). The bactDNA in eight patients had SBP that decreased by 1.6 log copies/µl after 48 h of antibiotic treatment and by 1.0 log copies/µl after 3 days of continued treatment. Conclusion BactDNA detection can be used to further enhance the diagnostic efficiency of SBP. Therefore, the application of ddPCR assay not only can be used to discriminate and quantify bacteria but also can be used in the clinical assessment for antibiotics treatment.
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Affiliation(s)
- Hao-Xin Wu
- Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Wei Hou
- Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Wei Zhang
- Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Zheng Wang
- Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Shan Guo
- Beijing Institute of Hepatology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - De-Xi Chen
- Beijing Institute of Hepatology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Zhen Li
- Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Feili Wei
- Beijing Institute of Hepatology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
- *Correspondence: Zhongjie Hu, ; Feili Wei,
| | - Zhongjie Hu
- Beijing YouAn Hospital, Capital Medical University, Beijing, China
- *Correspondence: Zhongjie Hu, ; Feili Wei,
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Català C, Velasco-de Andrés M, Casadó-Llombart S, Leyton-Pereira A, Carrillo-Serradell L, Isamat M, Lozano F. Innate immune response to peritoneal bacterial infection. Int Rev Cell Mol Biol 2022; 371:43-61. [PMID: 35965000 DOI: 10.1016/bs.ircmb.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Spontaneous and secondary peritoneal infections, mostly of bacterial origin, easily spread to cause severe sepsis. Cellular and humoral elements of the innate immune system are constitutively present in peritoneal cavity and omentum, and play an important role in peritonitis progression and resolution. This review will focus on the description of the anatomic characteristics of the peritoneal cavity and the composition and function of such innate immune elements under both steady-state and bacterial infection conditions. Potential innate immune-based therapeutic interventions in bacterial peritonitis alternative or adjunctive to classical antibiotic therapy will be briefly discussed.
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Affiliation(s)
- Cristina Català
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Sergi Casadó-Llombart
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | | | - Marcos Isamat
- Sepsia Therapeutics S.L. 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco Lozano
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Servei d'Immunologia, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Barcelona, Spain; Departament de Biomedicina, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain.
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Kanjanabuch T, Nopsopon T, Chatsuwan T, Purisinsith S, Johnson DW, Udomsantisuk N, Halue G, Lorvinitnun P, Puapatanakul P, Pongpirul K, Poonvivatchaikarn U, Tatiyanupanwong S, Chowpontong S, Chieochanthanakij R, Thamvichitkul O, Treamtrakanpon W, Saikong W, Parinyasiri U, Chuengsaman P, Dandecha P, Perl J, Tungsanga K, Eiam-Ong S, Sritippayawan S, Kantachuvesiri S. Predictors and outcomes of peritoneal dialysis-related infections due to filamentous molds (MycoPDICS). PLoS One 2022; 17:e0268823. [PMID: 35609049 PMCID: PMC9129032 DOI: 10.1371/journal.pone.0268823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/09/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction We sought to evaluate the predictors and outcomes of mold peritonitis in patients with peritoneal dialysis (PD). Methods This cohort study included PD patients from the MycoPDICS database who had fungal peritonitis between July 2015-June 2020. Patient outcomes were analyzed by Kaplan Meier curves and the Log-rank test. Multivariable Cox proportional hazards model regression was used to estimating associations between fungal types and patients’ outcomes. Results The study included 304 fungal peritonitis episodes (yeasts n = 129, hyaline molds n = 122, non-hyaline molds n = 44, and mixed fungi n = 9) in 303 patients. Fungal infections were common during the wet season (p <0.001). Mold peritonitis was significantly more frequent in patients with higher hemoglobin levels, presentations with catheter problems, and positive galactomannan (a fungal cell wall component) tests. Patient survival rates were lowest for non-hyaline mold peritonitis. A higher hazard of death was significantly associated with leaving the catheter in-situ (adjusted hazard ratio [HR] = 6.15, 95%confidence interval [CI]: 2.86–13.23) or delaying catheter removal after the diagnosis of fungal peritonitis (HR = 1.56, 95%CI: 1.00–2.44), as well as not receiving antifungal treatment (HR = 2.23, 95%CI: 1.25–4.01) or receiving it for less than 2 weeks (HR = 2.13, 95%CI: 1.33–3.43). Each additional day of antifungal therapy beyond the minimum 14-day duration was associated with a 2% lower risk of death (HR = 0.98, 95%CI: 0.95–0.999). Conclusion Non-hyaline-mold peritonitis had worse survival. Longer duration and higher daily dosage of antifungal treatment were associated with better survival. Deviations from the 2016 ISPD Peritonitis Guideline recommendations concerning treatment duration and catheter removal timing were independently associated with higher mortality.
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Affiliation(s)
- Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Bangkok, Thailand
- Center of Excellence in Kidney Metabolic Disorders, Bangkok, Thailand
- Peritoneal Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Dialysis Policy and Practice Program (Di3P), Bangkok, Thailand
- * E-mail:
| | | | - Tanittha Chatsuwan
- Department of Microbiology, Bangkok, Thailand
- Faculty of Medicine, Antimicrobial Resistance and Stewardship Research Unit, Chulalongkorn University, Bangkok, Thailand
| | | | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | | | - Guttiga Halue
- Department of Medicine, Phayao Hospital, Phayao, Thailand
| | - Pichet Lorvinitnun
- Department of Medicine, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand
| | - Pongpratch Puapatanakul
- Division of Nephrology, Department of Medicine, Bangkok, Thailand
- Peritoneal Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Bangkok, Thailand
| | | | - Sajja Tatiyanupanwong
- Nephrology Division, Department of Internal Medicine, Chaiyaphum Hospital, Chaiyaphum, Thailand
| | - Saowalak Chowpontong
- Division of Nephrology, Department of Medicine, Phra Nakhon Si Ayutthaya Hospital, Phra Nakhon Si Ayutthaya, Thailand
| | | | | | | | - Wadsamon Saikong
- Continuous Ambulatory Peritoneal Dialysis Clinic, Mukdahan Hospital, Mukdahan, Thailand
| | - Uraiwan Parinyasiri
- Kidney diseases clinic, Department of internal medicines, Songkhla Hospital, Songkhla, Thailand
| | - Piyatida Chuengsaman
- Banphaeo Dialysis Group (Bangkok), Banphaeo Hospital (Public organization), Bangkok, Thailand
| | - Phongsak Dandecha
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Bangkok, Thailand
| | - Suchai Sritippayawan
- Division Nephrology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Surasak Kantachuvesiri
- Division Nephrology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Zhao A, Andersson A, Backrud O, Heimbürger O. [Peritoneal dialysis-associated peritonitis caused by Rhizobium species - a case report]. Lakartidningen 2022; 119:21211. [PMID: 35603538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Peritonitis is a serious complication associated with high morbidity and mortality in patients with peritoneal dialysis (PD). We present a case of PD-associated peritonitis caused by the unusual pathogen Rhizobium. After therapy failure and bacterial growth despite treatment with vancomycin and tobramycin, the treatment was changed to meropenem intravenously and ciprofloxacin intraperitoneally according to antimicrobial susceptibility testing. The patient subsequently recovered without having the PD-catheter removed. To conclude, patients with PD are one of many patient groups at a greater risk of infections with unusual microbial agents, and pathogens that normally do not cause disease should be considered as potential causes of pathology when antibiotic treatment failure occurs.
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Affiliation(s)
- Allan Zhao
- läkarexamen, doktorand, institutionen för fysiologi och farmakologi, Karolinska institutet
| | - Anna Andersson
- biträdande överläkare, ME njurmedicin, Karolinska universitetssjukhuset
| | | | - Olof Heimbürger
- docent, överläkare, Karolinska institutet; ME njurmedicin, Karolinska universitetssjukhuset
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Saffo S, To UK, Santoiemma PP, Laurito M, Haque L, Rabiee A, Verna EC, Angarone MP, Garcia-Tsao G. Changes in Ascitic Fluid Polymorphonuclear Cell Count After Antibiotics Are Associated With Mortality in Spontaneous Bacterial Peritonitis. Clin Gastroenterol Hepatol 2022; 20:e1201-e1204. [PMID: 34273564 PMCID: PMC11090177 DOI: 10.1016/j.cgh.2021.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 02/07/2023]
Abstract
Spontaneous bacterial peritonitis (SBP) is a feared complication of ascites that affects 10%-30% of hospitalized patients with cirrhosis with an associated mortality rate of approximately 20%.1-3 Although efforts have been undertaken to encourage prompt evaluation and treatment of SBP, outcomes have generally remained dismal.3 There is significant interest in identifying factors that can reliably predict mortality among individuals with SBP.
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Affiliation(s)
- Saad Saffo
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut
| | - Uyen K To
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut
| | - Phillip P Santoiemma
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Marcela Laurito
- Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University, New York, New York
| | - Lamia Haque
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut
| | - Anahita Rabiee
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut
| | - Elizabeth C Verna
- Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University, New York, New York
| | - Michael P Angarone
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Guadalupe Garcia-Tsao
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut; Section of Digestive Diseases, VA Connecticut Healthcare System, West Haven, Connecticut.
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Rizwana MM, Appalaraju B. Salmonella paratyphi B - a rare cause of spontaneous bacterial peritonitis. INDIAN J PATHOL MICR 2022; 65:513-514. [PMID: 35435418 DOI: 10.4103/ijpm.ijpm_1390_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
| | - B Appalaraju
- Department of Microbiology, PSGIMSR, Coimbatore, Tamil Nadu, India
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50
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Fischer P, Pandrea S, Grigoras C, Stefanescu H, Farcau O, Tefas C, Socaciu C, Procopet B, Ionescu D. Blood Metabolomic Signatures to Identify Bacterial Infection in Patients with Decompensated Cirrhosis. J Gastrointestin Liver Dis 2022; 31:40-47. [PMID: 35306561 DOI: 10.15403/jgld-4034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/27/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND AIMS Bacterial infections are associated with high mortality rates in patients with decompensated cirrhosis. Early diagnosis with the available diagnostic tools is challenging. Metabolomics is a novel technique with a widespread application in hepatology. The aims of our study were to find new biomarkers for decompensated cirrhosis and for those with overlapping bacterial infections. METHODS 43 patients with compensated and 54 patients with decompensated cirrhosis were enrolled in the study. In patients with decompensation, a complete infectious workup was performed at admission. Blood and ascitic fluid were collected and stored at -80° C until performing the metabolomic analysis. Statistical analysis was performed using the Metaboanalyst 4.0 software. RESULTS 36 patients (66%) in the decompensated group were infected. Among them, 15 had multiple infections; thus, finally, 52 infections were diagnosed. The main metabolic pathways affected in patients with decompensated cirrhosis were those related to lipid metabolism, involving acylcarnitines, stearic acid derivatives, and 12/15 HETE-GABA. N-oleoyl ethanolamine was the most promising biomarker for bacterial infection diagnosis. Moreover, prostaglandin E2/D2/H2 and N-oleoyl alanine levels were higher in Gram- positive infections and ceramides (d16:2/18:0), in Gram-negative infections, respectively. L-phenylalanine (m/z=166.09) and lysophosphatidylethanolamine (18:3/0:0) were the two most relevant identified ascitic biomarkers for spontaneous bacterial peritonitis diagnosis. CONCLUSIONS The lipid and energetic metabolic pathways were the most affected in patients with decompensated cirrhosis and those with overlapping infections.
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Affiliation(s)
- Petra Fischer
- Gastroenterology and Hepatology Department, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj Napoca. .
| | - Stanca Pandrea
- Microbiology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
| | - Crina Grigoras
- Gastroenterology and Hepatology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
| | - Horia Stefanescu
- Gastroenterology and Hepatology Department, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj Napoca; Hepatology Deptartment, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj- Napoca, Romania.
| | - Oana Farcau
- Gastroenterology and Hepatology Department, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj Napoca; Hepatology Deptartment, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj- Napoca, Romania.
| | - Cristian Tefas
- Gastroenterology and Hepatology Department, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj Napoca; Hepatology Deptartment, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj- Napoca, Romania.
| | - Carmen Socaciu
- Department of Chemistry, Biochemistry and Molecular Biology, University of Agricultural Sciences and Veterinary Medicine, Cluj Napoca, Romania.
| | - Bogdan Procopet
- Gastroenterology and Hepatology Department, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj Napoca; Hepatology Deptartment, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj- Napoca, Romania.
| | - Daniela Ionescu
- Department of Anesthesia and Intensive Care I, University of Medicine and Pharmacy "Iuliu Hatieganu" , Cluj-Napoca, Romania; Anesthesia and Intensive Care Department, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania; Outcome Research Consortium Department Cleveland, USA.
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