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. 2024 Jun 5:16:17588359241258440.
doi: 10.1177/17588359241258440. eCollection 2024.

Diagnosis and treatment of bacterial peritonitis in patients with gastrointestinal cancer: an observational multicenter study

Alix Riescher-Tuczkiewicz  1 , Jules Grégory  2   3 , Frederic Bert  4 , Magaly Zappa  5 , Anna Pellat  6 , Valerie Lalande  7 , Claire Gallois  8 , Jean-Luc Mainardi  9 , Jean-Baptiste Bachet  10 , Jérôme Robert  11   12 , Anne Sophie Bourrel  13 , Romain Coriat  14 , Dominique Thabut  10 , Pascal Hammel  15 , Vinciane Rebours  10 , Diane Lorenzo  16
Affiliations

Diagnosis and treatment of bacterial peritonitis in patients with gastrointestinal cancer: an observational multicenter study

Alix Riescher-Tuczkiewicz et al. Ther Adv Med Oncol. .

Abstract

Background: Bacterial peritonitis (BP) in patients with gastrointestinal (GI) cancer has been poorly described, and its prevalence is unknown.

Objectives: This study aimed to evaluate in patients with both GI cancer and ascites the prevalence of BP, associated features, mechanisms, prognosis, and the diagnostic performance of neutrophil count in ascites.

Design: A retrospective, multicenter, observational study.

Methods: All patients with GI cancer and ascites who underwent at least one paracentesis sample analyzed for bacteriology over a 1-year period were included. BP was defined by a positive ascites culture combined with clinical and/or biological signs compatible with infection. Secondary BP was defined as BP related to a direct intra-abdominal infectious source.

Results: Five hundred fifty-seven ascites from 208 patients included were analyzed. Twenty-eight patients had at least one episode of BP and the annual prevalence rate of BP was 14%. Among the 28 patients with BP, 19 (65%) patients had proven secondary BP and 17 (59%) patients had multi-microbial BP, mainly due to Enterobacterales. A neutrophil count greater than 110/mm3 in ascites had negative and positive predictive values of 96% and 39%, respectively, for the diagnosis of BP. The median survival of patients with BP was 10 days (interquartile range 6-40) after the diagnosis.

Conclusion: BP is not rare in patients with GI cancer and is associated with a poor short-term prognosis. When a patient with GI cancer is diagnosed with BP, a secondary cause should be sought. Further studies are needed to better define the best management of these patients.

Keywords: Enterobacterales; ascites; diagnosis; infection; malignant ascites; secondary bacterial peritonitis.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Flow chart.
Figure 2.
Figure 2.
ROC curve of neutrophil count in ascites for the diagnosis of bacterial peritonitis in patients with gastrointestinal cancer. AUC, area under the curve; ROC, receiver operating characteristics.
Figure 3.
Figure 3.
Survival at 30 days after the first paracentesis in patients with gastrointestinal cancer with and without BP. BP, bacterial peritonitis.
Figure 4.
Figure 4.
Diagnostic algorithm of bacterial peritonitis in patients with gastrointestinal cancer. *Signs of infection refer to the presence of clinical (fever, abdominal pain) and/or biological (biological inflammatory syndrome) signs compatible with an infection. **Discussion between patient and clinician on the objective of care, taking into account the often poor prognosis, is suggested. CT-scan, computed tomography-scan.
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