Spontaneous ascitic infection in different cirrhotic groups: Prevalence, risk factors and the efficacy of cefotaxime therapy
Spontaneous ascitic infection in different cirrhotic groups: Prevalence, risk factors and the efficacy of cefotaxime therapy
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DOI：
10.1097/00042737-199701000-00017
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发表时间：
1997-01-01
影响因子：
2.1
通讯作者：
Besisik, F
中科院分区：
文献类型：
--
作者：
Kaymakoglu, S;Eraksoy, H;Besisik, F
目的：目的：探讨自发性腹水感染（SAI）在不同腹水组中的患病率，SAI发生的危险因素，以及头孢噻肟治疗的有效性。设计：一项前瞻性研究。设置：一所大学医院的住院患者门诊。B或D型肝炎病毒相关34例，酒精性18例，丙型肝炎病毒相关14例，其他14例。腹水采用腹水床旁接种血培养瓶的方法进行培养。SAI患者用头孢噻肟治疗结果：16例患者中有20例（22%）发生SAI，16例（20%）发生SAI，16例（20%）发生SAI，16例（20%）发生SAI，16例（20%）发生SAI。8例为自发性细菌性腹膜炎，2例为腹水，10例为培养阴性的巨噬细胞性腹水。B、D型肝炎肝硬化患者SAI发生率（32%）高于酒精性肝炎组（6%，P < 0.05）、丙型肝炎组（14%）和其他肝炎组（14%）。在多因素分析中，与SAI发展相关的独立预测因素是慢性8型肝炎病毒感染、腹水总蛋白和血清胆红素。10例阳性腹水培养中5例检出大肠埃希菌。95%的病例感染治愈。结论：自发性腹水感染约占住院腹水患者的20%。腹水蛋白浓度低、血清胆红素水平高或B型肝炎肝硬化患者更易发生SAI。头孢噻肟可作为治疗腹水感染的首选抗生素。
Objective: To investigate the prevalence of spontaneous ascitic infection (SAI) in different cirrhotic groups, the risk factors for development of SAI, and the efficacy of cefotaxime therapy.Design: A prospective study.Setting: In-patient clinic of a university hospital.Patients: Eighty cirrhotic patients with ascites were assigned to four groups: hepatitis B or D virus-related 34, alcoholic 18, hepatitis C virus-related 14, miscellaneous 14.Interventions: Paracentesis was performed on 80 patients during 92 consecutive hospitalizations. Ascitic fluid was cultured by the method of bedside inoculation of blood culture bottles with ascites. The patients with SAI were treated with cefotaxime (2 g, three times daily, intravenously) for 5 days.Main outcome measures: Frequency of SAI in cirrhotic groups; clinical, bacteriological and biochemical findings of SAI; rate of recovery from infection.Results: Twenty SAI episodes (22%) were found in 16 patients; 8 episodes were spontaneous bacterial peritonitis, 2 bacterascites, and 10 culture-negative neutrocytic ascites. SAI occurred more frequently in patients with hepatitis B or D virus-related liver cirrhosis (32%) than in the alcoholic (6%, P < 0.05), hepatitis C virus-related (14%) or miscellaneous (14%) cirrhotic groups. In multivariate analysis, independent predictive factors associated with the development of SAI are chronic hepatitis 8 virus infection, ascitic fluid total protein and serum bilirubin. Escherichia coli was obtained in 5 of 10 positive ascitic fluid cultures. Cure of the infection was achieved in 95% of episodes. Hospitalization mortality rate in infected patients was 20%.Conclusion: Spontaneous ascitic infection occurs in approximately 20% of cirrhotic patients hospitalized with ascites. The patients with low ascitic protein concentration, high serum bilirubin level or hepatitis B virus cirrhosis are more predisposed to SAI. Cefotaxime may be an effective first-choice antibiotic for ascitic fluid infection.