Prevalence and clinical outcome of spontaneous bacterial peritonitis in hospitalized patients with liver cirrhosis: a prospective observational study in central part of Croatia

Abstract

Spontaneous bacterial peritonitis (SBP) is a serious complication of liver cirrhosis and is defined as infected ascites in the absence of any recognizable secondary cause of infection. The aim of the study was to evaluate the prevalence, incidence, pathogens and clinical outcome of SBP. This prospective observational study included 108 cirrhotic patients with ascites treated during 18 months. Patients were divided into two groups according to diagnostic criteria of SBP: SBP group (n=23) and non-SBP group (n=85). Differences in clinical outcomes between the two groups were analyzed, including mortality rate, incidence of gastrointestinal bleeding, bacteremia/sepsis and frequency of rehospitalization. The pathogens responsible for SBP were analyzed in SBP group. The prevalence of SBP was 21% and incidence 14.1% per year. Statistically significant between-group differences were recorded in mortality (26% vs. 4.7%; P=0.017), incidence of gastrointestinal bleeding (39% vs. 11.7%; P=0.015) and rehospitalization frequency (47.8% vs. 20%; P=0.05). The incidence of sepsis following episode of gastrointestinal bleeding was similar in both groups (55.5% vs. 50%; P=0.892). The following pathogens were responsible for SBP: Escherichia coli (n=7), MRSA (n=2), Acinetobacter spp. (n=2), Staphylococcus aureus (n=1), Streptococcus spp. (n=1), Staphylococcus epidermidis (n=1) and Enterococcus faecalis (n=1). As indicated by study results, the incidence and mortality of SBP were high. Patients with liver cirrhosis and gastrointestinal hemorrhage were found to be at a high risk of developing sepsis with or without clinically proven SBP. The pathogens responsible for SBP were mostly gram-negative microorganisms; however, there were also a significant proportion of gram-positive microorganisms and hospital infections with antibiotic-resistant bacteria. Study results suggested the spectrum of pathogens to change due to the selection of antibiotic-resistant bacteria within the hospital setting.