Appropriate and timely antimicrobial therapy in cirrhotic patients with spontaneous bacterial peritonitis-associated septic shock: a retrospective cohort study
Appropriate and timely antimicrobial therapy in cirrhotic patients with spontaneous bacterial peritonitis-associated septic shock: a retrospective cohort study
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DOI：
10.1111/apt.13135
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发表时间：
2015-04-01
影响因子：
7.6
通讯作者：
Kumar, A.
中科院分区：
文献类型：
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作者：
Karvellas, C. J.;Abraldes, J. G.;Kumar, A.
背景自发性细菌性腹膜炎（SBP）相关的感染性休克在肝硬化患者中具有显著的死亡率。目的确定抗菌治疗的实践相关方面是否导致高死亡率。方法对所有（n=126）自发性细菌性腹膜炎患者进行回顾性队列研究（中性粒细胞计数>250或腹水培养阳性）相关的脓毒性休克（1996-2011）。适当的抗菌治疗意味着无论是在体外活性对随后分离的病原体（培养阳性）或经验性管理与广泛接受的规范（培养阴性）。将幸存者（n=23）与非幸存者（n=103）进行比较，幸存者的急性生理学和慢性健康评估（APACHEII）较低（平均值. d.; 22 +/- 7 vs. 32 +/- 8）和终末期肝病（MELD）模型（24 +/- 9 vs. 34 +/- 11）评分和入院时血清乳酸（4.9 +/- 3.1 vs. 8.9 +/- 5.3），P
BackgroundSpontaneous bacterial peritonitis (SBP)-associated septic shock carries significant mortality in cirrhosis.AimTo determine whether practice-related aspects of antimicrobial therapy contribute to high mortality.MethodsRetrospective cohort study of all (n=126) cirrhotics with spontaneous bacterial peritonitis (neutrophil count >250 or positive ascitic culture)-associated septic shock (1996-2011) from an international, multicenter database. Appropriate antimicrobial therapy implied either in vitro activity against a subsequently isolated pathogen (culture positive) or empiric management consistent with broadly accepted norms (culture negative).ResultsOverall hospital mortality was 81.8%. Comparing survivors (n=23) with non-survivors (n=103), survivors had lower Acute Physiology and Chronic Health Evaluation (APACHEII) (means.d.; 22 +/- 7 vs. 32 +/- 8) and model for end-stage liver disease (MELD) (24 +/- 9 vs. 34 +/- 11) scores and serum lactate on admission (4.9 +/- 3.1 vs. 8.9 +/- 5.3), P