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. 2018 Dec;38(12):2199-2209.
doi: 10.1111/liv.13929. Epub 2018 Aug 10.

Bacterascites: A study of clinical features, microbiological findings, and clinical significance

Rosalie C Oey  1 , Henk R van Buuren  1 , David M de Jong  1 , Nicole S Erler  2 , Robert A de Man  1
Affiliations

Bacterascites: A study of clinical features, microbiological findings, and clinical significance

Rosalie C Oey et al. Liver Int. 2018 Dec.

Abstract

Background: Knowledge about bacterascites is limited and management guidelines are based on small patient series. The purpose of this study was to add further insight into the clinical characteristics, microbiological findings, and prognosis of patients diagnosed with bacterascites.

Methods: Retrospective analysis of patients with advanced chronic liver disease diagnosed with bacterascites and SBP between January 2003 and August 2016.

Results: In this study, 123 patients were included with 142 episodes of bacterascites. The median MELD score was 20 and clinical symptoms of infection were present in 78%. Empiric antibiotic treatment was initiated in 68%. In 26 untreated patients undergoing repeated paracentesis, 42% were diagnosed with either ongoing bacterascites or SBP. The presence of signs or symptoms of infection was not an independent predictor for mortality or spontaneous resolution of infection. The 1-month and 1-year mortality rates of the 123 patients studied, were 32% and 60%, respectively; these results were in line with data pertaining to the prognosis of SBP.

Conclusions: Patients with bacterascites and SBP are highly comparable with respect to severity of liver disease and overall prognosis. If left untreated, bacterascites is likely to persist or to evolve to SBP in a significant proportion of patients. The results of this study support current guidelines regarding the treatment of ascitic fluid infection, but could not confirm the prognostic relevance of symptomatic disease at the time of diagnosis. We suggest that the threshold to initiate antibiotic treatment, in particular in cases with severely advanced liver disease, should be low.

Keywords: bacterascites; cirrhosis; microbiology; spontaneous bacterial peritonitis.

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Figures

Figure 1
Figure 1
Type of pathogens cultured in 142 bacterascites episodes classified by genus
Figure 2
Figure 2
The clinical course of patients with bacterascites without antibiotic treatment
Figure 3
Figure 3
Comparable cumulative survival curves shown for 114 patients with bacterascites (red solid line) and 88 patients with SBP (blue solid line) (log‐rank test P = 0.3973). The dashed lines with corresponding colours display the 95% confidence interval
Figure 4
Figure 4
The figure shows a MELD score‐dependent relation for the 3‐month survival after bacterascites diagnosis of 114 patients (blue line). The survival of 88 patients with SBP (red line) and advanced chronic liver disease without ascites infection (green line) are plotted for comparison
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References

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