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Peritonitis NOT "spontaneous bacterial peritonitis"

Maurizio Koch
Microbes are mostly important for the digestion of food, the absorption of some micronutrients, and the production of vitamins. The microbiota stimulates lymphoid structures in the gastrointestinal mucosa and decrease pathogens by competing for nutrients and space. Bacterial translocation is defined as the escape of gut bacteria and their products through the intestinal mucosa to the outside of the intestine as portovenous or systemic circulation. This is induced by a leaky gut barrier. There is evidence for a role of intestinal permeability in the pathogenesis of nonalcoholic fatty liver disease...
November 2016: Journal of Clinical Gastroenterology
Omar D Borjas-Almaguer, Carlos A Cortez-Hernández, Emmanuel I González-Moreno, Francisco J Bosques-Padilla, José A González-González, Aldo A Garza, Juan A Martínez-Segura, Diego García-Compean, Juan V Alejandre-Loya, Jesús García-García, Guillermo Delgado-García, Héctor J Maldonado-Garza
:  Background & Aims. It is unclear whether portal vein thrombosis (PVT) unrelated to malignancy is associated with reduced survival or it is an epiphenomenon of advanced cirrhosis. The objective of this study was to assess clinical outcome in cirrhotic patients with PVT not associated with malignancy and determine its prevalence. MATERIAL AND METHODS: Retrospective search in one center from June 2011 to December 2014. RESULTS: 169 patients, 55 women and 114 men, median age 54 (19-90) years...
November 2016: Annals of Hepatology
Mamatha Bhat, Bianca M Arendt, Venkat Bhat, Eberhard L Renner, Atul Humar, Johane P Allard
The intestinal microbiome (IM) is altered in patients with cirrhosis, and emerging literature suggests that this impacts on the development of complications. The PubMed database was searched from January 2000 to May 2015 for studies and review articles on the composition, pathophysiologic effects and therapeutic modulation of the IM in cirrhosis. The following combination of relevant text words and MeSH terms were used, namely intestinal microbiome, microbiota, or dysbiosis, and cirrhosis, encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, variceal bleeding, hepatopulmonary syndrome, portopulmonary hypertension and hepatocellular carcinoma...
September 28, 2016: World Journal of Hepatology
Marco Fiore, Sebastiano Leone
Spontaneous bacterial peritonitis is a complication of ascitic patients with end-stage liver disease (ESLD); spontaneous fungal peritonitis (SFP) is a complication of ESLD less known and described. ESLD is associated to immunodepression and the resulting increased susceptibility to infections. Recent perspectives of the management of the critically ill patient with ESLD do not specify the rate of isolation of fungi in critically ill patients, not even the antifungals used for the prophylaxis, neither optimal treatment...
September 14, 2016: World Journal of Gastroenterology: WJG
Aparna Goel, Mollie Biewald, Shirish Huprikar, Thomas Schiano, Gene Y Im
BACKGROUND: Spontaneous bacterial peritonitis (SBP) is a common infection in cirrhosis associated with high mortality. More than 20% of patients with SBP do not respond to initial antibiotics. Guidelines differ in recommendations to repeat paracentesis (retap) to confirm antibiotic efficacy. We aim to evaluate the effect of retap-guided management of SBP on antibiotic escalation and 30-day transplant-free survival. MATERIALS AND METHODS: Retrospective cohort study of cirrhotic patients with SBP admitted to a single transplant center from 2010 to 2014...
September 22, 2016: Journal of Clinical Gastroenterology
Thierry Thévenot, Charline Briot, Vincent Macé, Hortensia Lison, Laure Elkrief, Alexandra Heurgué-Berlot, Christophe Bureau, Caroline Jézéquel, Ghassan Riachi, Alexandre Louvet, Arnaud Pauwels, Isabelle Ollivier-Hourmand, Rodolphe Anty, Nicolas Carbonell, Hélène Labadie, Karim Aziz, Denis Grasset, Eric Nguyen-Khac, Mehdi Kaassis, Sofia Hermann, Florence Tanné, Thomas Mouillot, Olivier Roux, Aurélie Le Thuaut, Jean-Paul Cervoni, Jean-François Cadranel, Matthieu Schnee
OBJECTIVES: We aimed to assess the performance of a new strip (Periscreen) for the rapid diagnosis of spontaneous bacterial peritonitis (SBP). METHODS: Ascitic fluid (AF) of cirrhotic patients hospitalized between March 2014 and August 2015 was independently tested by two readers using the new strip, which has four colorimetric graduations (negative, trace, small, and large). SBP was diagnosed on neutrophils in ascites>250/mm(3). Ascites not related to portal hypertension were excluded...
October 2016: American Journal of Gastroenterology
Javier Fernández, Juan Acevedo, Verónica Prado, Mario Mercado, Miriam Castro, Marco Pavesi, Mireya Arteaga, Lydia Sastre, Adria Juanola, Pere Ginès, Vicente Arroyo
: Clinical course and risk factors of death in non-SBP infections are poorly known. We assessed the prevalence of AKI and type-1 HRS, hospital, 30-d and 90-d mortality and risk factors of death in 441 decompensated patients. METHODS: Analysis of 615 non-SBP infections (161 urinary infections, 95 cellulitis, 92 suspected infections, 92 bacteremias, 84 pneumonias, 21 bronchitis, 18 cholangitis, 15 spontaneous empyema, 13 secondary peritonitis, 24 other). RESULTS: 96% of infections solved...
August 25, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
Rym Ennaifer, Nour Elleuch, Hayfa Romdhane, Rania Hefaiedh, Maryem Cheikh, Sonda Chaabouni, Houda Ben Nejma, Najet Bel Hadj
BACKGROUND: Ascitic decompensation is a common major complication of cirrhosis and is associated with a poor outcome. In 5-10% of patients, ascites become resistant to treatment (either do not respond to a high dose of diuretics or because these drugs induce complications), which is called refractory ascites (RA). RA is associated with poor survival: 20-50% at 1 year. The aim of this study was to investigate the outcome of RA. METHODS: Retrospective study including consecutive cirrhotic patients admitted for controlling ascites between January 2010 and April 2013...
January 2016: La Tunisie Médicale
Asem Elfert, Lobna Abo Ali, Samah Soliman, Shimaa Ibrahim, Sherief Abd-Elsalam
BACKGROUND AND AIMS: Spontaneous bacterial peritonitis (SBP) is a serious complication of liver cirrhosis with a high recurrence rate and a marked increase in mortality. Norfloxacin is used widely for the secondary prophylaxis of SBP; however, its extensive long-term use has led to an increase in the incidence of quinolone-resistant and Gram-positive SBP. Rifaximin is a nonabsorbable broad-spectrum antibiotic and does not appear to promote emergence of resistance. The aim of this study was to compare the safety and efficacy of rifaximin versus norfloxacin for the secondary prevention of SBP in patients with liver cirrhosis and ascites...
August 10, 2016: European Journal of Gastroenterology & Hepatology
Nathan T Douthit, Hailemariam Alemu Astatk
This is a case report of a 24-year-old Ethiopian woman with a medical history of hepatosplenic schistosomiasis. She suffers from chronic liver failure and portal hypertension. She has been hospitalised for 'hysteria' in the past but did not receive follow-up, outpatient treatment or psychiatric evaluation. After discontinuing her medications and leaving her family to use holy water, a religious medicine used by many Ethiopians, she was found at a nearby monastery. She was non-communicative and difficult to arouse...
2016: BMJ Case Reports
Gitte Dam, Hendrik Vilstrup, Hugh Watson, Peter Jepsen
UNLABELLED: Proton pump inhibitors (PPIs) may be a risk factor for hepatic encephalopathy (HE) in patients with cirrhosis, possibly through translocation of gut bacteria, which can also lead to spontaneous bacterial peritonitis (SBP). We examined the associations between PPIs and development of HE or SBP in patients with cirrhosis with ascites. We used data from three 1-year trials of satavaptan for ascites control. We used Cox regression to compare HE and SBP rates between users and nonusers of PPIs...
October 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Jason Reinglas, Kayvan Amjadi, Bill Petrcich, Franco Momoli, Thomas Shaw-Stiffel
Background. Treatment options are limited for patients with refractory cirrhotic ascites (RCA). As such, we assessed the safety and effectiveness of the PleurX catheter for RCA. Methods. A retrospective analysis was performed on all patients with RCA who have undergone insertion of the PleurX catheter between 2007 and 2014 at our clinic. Results. Thirty-three patients with RCA were included in the study; 4 patients were lost to follow-up. All patients were still symptomatic despite bimonthly large volume paracentesis and were not candidates for TIPS or PV shunt...
2016: Canadian Journal of Gastroenterology & Hepatology
Tobias Lahmer, Andreas Brandl, Sebastian Rasch, Roland M Schmid, Wolfgang Huber
INTRODUCTION: Spontaneous peritonitis, especially spontaneous fungal peritonitis (SFP), is an important and potentially fatal complication in patients with endstage liver disaese. We evaluated potential risk factors, microbiological findings, and outcome of patients with SFP compared to spontaneous bacterial peritonitis (SBP) in critically ill patients. METHODS: Retrospective analyses of critically ill patients with suspected spontaneous peritonitis. RESULTS: Out of 205 patients, 20 (10%) had SFP, 28 (14%) had SBP, 48 (24%) had peritonitis without microbiological findings (SP) and 109 (52%) had no-peritonitis (NP)...
2016: PloS One
Francesco Salerno, Mauro Borzio, Claudia Pedicino, Rosa Simonetti, Angelo Rossini, Sergio Boccia, Irene Cacciola, Andrew K Burroughs, Matteo Angelo Manini, Vincenzo La Mura, Paolo Angeli, Mauro Bernardi, Daniela Dalla Gasperina, Elena Dionigi, Clara Dibenedetto, Milena Arghittu
Bacterial strains resistant to antibiotics are a serious clinical challenge. We assessed the antibiotic susceptibility of bacteria isolated from infections in patients with cirrhosis by a multicentre investigation RESULTS: Three-hundred-thirteen culture-positive infections (173 community-acquired and 140 hospital-acquired) were identified in 308 patients. Urinary tract infections, spontaneous bacterial peritonitis and bacteremias were the most frequent. Quinolone-resistant Gram-negative isolates were 48%, 44% were ESBL producers and 9% carbapenem-resistant...
July 1, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
Seongman Bae, Taeeun Kim, Min-Chul Kim, Yong Pil Chong, Sung-Han Kim, Heungsup Sung, Young-Suk Lim, Sang-Oh Lee, Mi-Na Kim, Yang Soo Kim, Jun Hee Woo, Sang-Ho Choi
BACKGROUND: Enterobacter species are important nosocomial pathogens, and there is growing concern about their ability to develop resistance during antimicrobial therapy. However, few data are available on the clinical characteristics and outcomes of Enterobacter spontaneous bacterial peritonitis (SBP). METHODS: We retrospectively identified all patients with SBP caused by Enterobacter species admitted to a tertiary care hospital between January 1997 and December 2013...
2016: BMC Infectious Diseases
J Leong, S Huprikar, T Schiano
BACKGROUND: Spontaneous bacterial peritonitis (SBP) carries appreciable morbidity and mortality in the pre-liver transplant (LT) setting. However, the occurrence of SBP and its consequences in the post-LT setting have not been well characterized. METHODS: This is a retrospective study of SBP occurring in post-LT patients between January 2007 and December 2012. Outcomes were compared to a cohort of post-LT patients with allograft failure and ascites without SBP. RESULTS: The most common indication for liver transplantation in this cohort was hepatitis C...
August 2016: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Taeeun Kim, Sun In Hong, Se Yoon Park, Jiwon Jung, Yong Pil Chong, Sung-Han Kim, Sang-Oh Lee, Yang Soo Kim, Jun Hee Woo, Young-Suk Lim, Heungsup Sung, Mi-Na Kim, Sang-Ho Choi
Streptococcus pneumoniae is a well-known cause of spontaneous bacterial peritonitis (SBP) in cirrhotic patients. However, little information is available regarding clinical characteristics and outcomes of SBP caused by S. pneumoniae. It has been suggested that spontaneous pneumococcal peritonitis (SPP) often spreads hematogenously from concomitant pneumococcal pneumonia, and is associated with a higher rate of mortality.During the period between January 1997 and December 2013, 50 SPP cases were identified. These cases were then age/sex-matched with 100 patients with SBP due to causes other than S...
May 2016: Medicine (Baltimore)
Oriol Juanola, Isabel Gómez-Hurtado, Pedro Zapater, Alba Moratalla, Esther Caparrós, Paula Piñero, José M González-Navajas, Paula Giménez, José Such, Rubén Francés
BACKGROUND&AIMS: Norfloxacin exerts immunomodulatory effects in cirrhosis beyond its bactericidal activity. We aimed at identifying the role of regulatory T (Treg) cells in the norfloxacin mechanism that compensates the inflammatory environment in cirrhosis. PATIENTS&METHODS: Consecutively admitted patients with cirrhosis and ascitic fluid (AF) with: spontaneous bacterial peritonitis (SBP), non-infected AF, and norfloxacin as secondary SBP prophylaxis (SID group)...
May 23, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
Osman Cavit Özdoğan
No abstract text is available yet for this article.
May 2016: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
Guadalupe Garcia-Tsao
Cirrhosis is not a single entity but represents a disease progression across different prognostic stages, with the compensated and decompensated stages being the most important. Variceal hemorrhage (VH) and ascites are complications of cirrhosis that denote the presence of a decompensated stage. Spontaneous bacterial peritonitis (SBP) is a common bacterial infection unique to patients with cirrhosis that can precipitate the development of recurrent VH and hepatorenal syndrome (HRS), complications that denote the presence of a 'further decompensated' stage of cirrhosis...
2016: Digestive Diseases
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