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Current Hepatology Reports
Erschienen in: Current Hepatology Reports 3/2017

19.07.2017 | Management of the Cirrhotic Patient (A Cardenas and N Reau, Section Editors)

Current Trends in the Management of Spontaneous Bacterial Peritonitis

verfasst von: Chanda K. Ho, Sumeet K. Asrani

Erschienen in: Current Hepatology Reports | Ausgabe 3/2017

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Abstract

Purpose of review

Spontaneous bacterial peritonitis is a life-threatening infection that is a leading cause of mortality among patients with decompensated cirrhosis. In this article, we present current trends in the management of spontaneous bacterial peritonitis (SBP), highlighting treatment failure rates of traditional regimens and ways in which to address such challenges.

Recent findings

Despite available management guidelines, there are data to support that these guidelines are often not adhered to, e.g., performing a diagnostic paracentesis at the time of hospital admission in a patient with ascites. Management of SBP is now further complicated by resistant organisms and an increasing prevalence of nosocomial and healthcare-associated infections.

Summary

Effective treatment of SBP requires careful consideration of patient risk factors, local antibiotic resistance patterns, and clinical presentation.
Literatur
1.
Hoefs JC, Canawati HN, Sapico FL, Hopkins RR, Weiner J, Montgomerie JZ. Spontaneous bacterial peritonitis. Hepatology(Baltimore, Md). 1982;2(4):399–407.PubMedCrossRef
2.
Wiest R, Krag A, Gerbes A. Spontaneous bacterial peritonitis: recent guidelines and beyond. Gut. 2012;61(2):297–310.PubMedCrossRef
3.
de Mattos AA, Costabeber AM, Lionco LC, Tovo CV. Multi-resistant bacteria in spontaneous bacterial peritonitis: a new step in management? World J Gastroenterol. 2014;20(39):14079–86.PubMedPubMedCentralCrossRef
4.
• Goel A, Biewald M, Huprikar S, Schiano T, Im GY. A real-world evaluation of repeat paracentesis-guided management of spontaneous bacterial peritonitis. J Clin Gastroenterol. 2017;51(3):278–84. This study highlights real-world outcomes in SBP at a US center, including high rates of treatment failure and resistant infections. This study supports repeat paracentesis at 48 hours. PubMed
5.
Chinnock B, Afarian H, Minnigan H, Butler J, Hendey GW. Physician clinical impression does not rule out spontaneous bacterial peritonitis in patients undergoing emergency department paracentesis. Ann Emerg Med. 2008;52(3):268–73.PubMedCrossRef
6.
EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol 2010;53(3):397–417.
7.
Runyon BA. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology(Baltimore, Md). 2013;57(4):1651–3.PubMedCrossRef
8.
Dever JB, Sheikh MY. Review article: spontaneous bacterial peritonitis—bacteriology, diagnosis, treatment, risk factors and prevention. Aliment Pharmacol Ther. 2015;41(11):1116–31.PubMedCrossRef
9.
Runyon BA, Hoefs JC. Culture-negative neutrocytic ascites: a variant of spontaneous bacterial peritonitis. Hepatology(Baltimore, Md). 1984;4(6):1209–11.PubMedCrossRef
10.
de Vos M, De Vroey B, Garcia BG, Roy C, Kidd F, Henrion J, et al. Role of proton pump inhibitors in the occurrence and the prognosis of spontaneous bacterial peritonitis in cirrhotic patients with ascites. Liver Int. 2013;33(9):1316–23.PubMedCrossRef
11.
Bunchorntavakul C, Chamroonkul N, Chavalitdhamrong D. Bacterial infections in cirrhosis: a critical review and practical guidance. World J Hepatol. 2016;8(6):307–21.PubMedPubMedCentralCrossRef
12.
Baskol M, Gursoy S, Baskol G, Ozbakir O, Guven K, Yucesoy M. Five days of ceftriaxone to treat culture negative neutrocytic ascites in cirrhotic patients. J Clin Gastroenterol. 2003;37(5):403–5.PubMedCrossRef
13.
Fernandez J, Navasa M, Gomez J, Colmenero J, Vila J, Arroyo V, et al. Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology(Baltimore, Md). 2002;35(1):140–8.PubMedCrossRef
14.
• Piano S, Fasolato S, Salinas F, Romano A, Tonon M, Morando F, et al. The empirical antibiotic treatment of nosocomial spontaneous bacterial peritonitis: results of a randomized, controlled clinical trial. Hepatology (Baltimore, Md). 2016;63(4):1299–309. This is the first randomized controlled clinical trial to compare broad spectrum antibiotics against 3rd generation cephalopsorins in the treatment of nosocomial SBP. Given increasing prevalence of nosocomial pathogens, this study established improved survival in broader spectrum antibiotic group. CrossRef
15.
Ariza X, Castellote J, Lora-Tamayo J, Girbau A, Salord S, Rota R, et al. Risk factors for resistance to ceftriaxone and its impact on mortality in community, healthcare and nosocomial spontaneous bacterial peritonitis. J Hepatol. 2012;56(4):825–32.PubMedCrossRef
16.
Fernandez J, Acevedo J, Castro M, Garcia O, de Lope CR, Roca D, et al. Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: a prospective study. Hepatology(Baltimore, Md). 2012;55(5):1551–61.PubMedCrossRef
17.
Merli M, Lucidi C, Di Gregorio V, Lattanzi B, Giannelli V, Giusto M, et al. An empirical broad spectrum antibiotic therapy in health-care-associated infections improves survival in patients with cirrhosis: a randomized trial. Hepatology(Baltimore, Md). 2016;63(5):1632–9.PubMedCrossRef
18.
• Jalan R, Fernandez J, Wiest R, Schnabl B, Moreau R, Angeli P, et al. Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. J Hepatol. 2014;60(6):1310–24. This is a position paper based on the EASL Special Conference 2013 on bacterial infections in cirrhosis. This is an important adjunct to the EASL clinical practice guidelines on the management of SBP (published 2010) and the AASLD clinical practice guidelines (last updated in 2012). PubMedCrossRef
19.
Salerno F, Gerbes A, Gines P, Wong F, Arroyo V. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut. 2007;56(9):1310–8.PubMedPubMedCentral
20.
Follo A, Llovet JM, Navasa M, Planas R, Forns X, Francitorra A, et al. Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis. Hepatology(Baltimore, Md). 1994;20(6):1495–501.PubMedCrossRef
21.
Sort P, Navasa M, Arroyo V, Aldeguer X, Planas R, Ruiz-del-Arbol L, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med. 1999;341(6):403–9.PubMedCrossRef
22.
Salerno F, Navickis RJ, Wilkes MM. Albumin infusion improves outcomes of patients with spontaneous bacterial peritonitis: a meta-analysis of randomized trials. Clinical Gastroenterol Hepatol. 2013;11(2):123–30. e1 CrossRef
23.
Valerio C, Theocharidou E, Davenport A, Agarwal B. Human albumin solution for patients with cirrhosis and acute on chronic liver failure: beyond simple volume expansion. World J Hepatol. 2016;8(7):345–54.PubMedPubMedCentralCrossRef
24.
Fernandez J, Navasa M, Planas R, Montoliu S, Monfort D, Soriano G, et al. Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. Gastroenterology. 2007;133(3):818–24.PubMedCrossRef
25.
Assem M, Elsabaawy M, Abdelrashed M, Elemam S, Khodeer S, Hamed W, et al. Efficacy and safety of alternating norfloxacin and rifaximin as primary prophylaxis for spontaneous bacterial peritonitis in cirrhotic ascites: a prospective randomized open-label comparative multicenter study. Hepatol Int. 2016;10(2):377–85.PubMedCrossRef
26.
Hanouneh MA, Hanouneh IA, Hashash JG, Law R, Esfeh JM, Lopez R, et al. The role of rifaximin in the primary prophylaxis of spontaneous bacterial peritonitis in patients with liver cirrhosis. J Clin Gastroenterol. 2012;46(8):709–15.PubMedCrossRef
27.
Vlachogiannakos J, Viazis N, Vasianopoulou P, Vafiadis I, Karamanolis DG, Ladas SD. Long-term administration of rifaximin improves the prognosis of patients with decompensated alcoholic cirrhosis. J Gastroenterol Hepatol. 2013;28(3):450–5.PubMedCrossRef
28.
Fernandez J, Ruiz del Arbol L, Gomez C, Durandez R, Serradilla R, Guarner C, et al. Norfloxacin vs ceftriaxone in the prophylaxis of infections in patients with advanced cirrhosis and hemorrhage. Gastroenterology. 2006;131(4):1049–56. quiz 285PubMedCrossRef
29.
Soriano G, Guarner C, Tomas A, Villanueva C, Torras X, Gonzalez D, et al. Norfloxacin prevents bacterial infection in cirrhotics with gastrointestinal hemorrhage. Gastroenterology. 1992;103(4):1267–72.PubMedCrossRef
30.
Elfert A, Abo Ali L, Soliman S, Ibrahim S, Abd-Elsalam S. Randomized-controlled trial of rifaximin versus norfloxacin for secondary prophylaxis of spontaneous bacterial peritonitis. Eur J Gastroenterol Hepatol. 2016;28(12):1450–4.PubMedCrossRef
31.
Garcia-Tsao G, Bosch J. Varices and variceal hemorrhage in cirrhosis: anew view of an old problem. Clin Gastroenterol Hepatol. 2015;13(12):2109–17.PubMedPubMedCentralCrossRef
32.
Lebrec D, Nouel O, Corbic M, Benhamou JP. Propranolol—a medical treatment for portal hypertension? Lancet(London, England). 1980;2(8187):180–2.PubMedCrossRef
33.
Ge PS, Runyon BA. The changing role of beta-blocker therapy in patients with cirrhosis. J Hepatol. 2014;60(3):643–53.PubMedCrossRef
34.
Serste T, Francoz C, Durand F, Rautou PE, Melot C, Valla D, et al. Beta-blockers cause paracentesis-induced circulatory dysfunction in patients with cirrhosis and refractory ascites: a cross-over study. J Hepatol. 2011;55(4):794–9.PubMedCrossRef
35.
Serste T, Melot C, Francoz C, Durand F, Rautou PE, Valla D, et al. Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites. Hepatology(Baltimore, Md). 2010;52(3):1017–22.PubMedCrossRef
36.
Krag A, Wiest R, Albillos A, Gluud LL. The window hypothesis: haemodynamic and non-haemodynamic effects of beta-blockers improve survival of patients with cirrhosis during a window in the disease. Gut. 2012;61(7):967–9.PubMedCrossRef
37.
Groszmann RJ, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Planas R, et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med. 2005;353(21):2254–61.PubMedCrossRef
38.
Krag A, Bendtsen F, Henriksen JH, Moller S. Low cardiac output predicts development of hepatorenal syndrome and survival in patients with cirrhosis and ascites. Gut. 2010;59(1):105–10.PubMedCrossRef
39.
Madsen BS, Havelund T, Krag A. Targeting the gut-liver axis in cirrhosis: antibiotics and non-selective beta-blockers. Adv Ther. 2013;30(7):659–70.PubMedCrossRef
40.
Perez-Paramo M, Munoz J, Albillos A, Freile I, Portero F, Santos M, et al. Effect of propranolol on the factors promoting bacterial translocation in cirrhotic rats with ascites. Hepatology(Baltimore, Md). 2000;31(1):43–8.PubMedCrossRef
41.
Reiberger T, Ferlitsch A, Payer BA, Mandorfer M, Heinisch BB, Hayden H, et al. Non-selective betablocker therapy decreases intestinal permeability and serum levels of LBP and IL-6 in patients with cirrhosis. J Hepatol. 2013;58(5):911–21.PubMedCrossRef
42.
Senzolo M, Cholongitas E, Burra P, Leandro G, Thalheimer U, Patch D, et al. beta-Blockers protect against spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis. Liver Int. 2009;29(8):1189–93.PubMedCrossRef
43.
Mandorfer M, Bota S, Schwabl P, Bucsics T, Pfisterer N, Kruzik M, et al. Nonselective beta blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis. Gastroenterology. 2014;146(7):1680–90. e1 PubMedCrossRef
44.
Bossen L, Krag A, Vilstrup H, Watson H, Jepsen P. Nonselective beta-blockers do not affect mortality in cirrhosis patients with ascites: post hoc analysis of three randomized controlled trials with 1198 patients. Hepatology(Baltimore, Md). 2016;63(6):1968–76.PubMedCrossRef
45.
Leithead JA, Rajoriya N, Tehami N, Hodson J, Gunson BK, Tripathi D, et al. Non-selective beta-blockers are associated with improved survival in patients with ascites listed for liver transplantation. Gut. 2015;64(7):1111–9.PubMedCrossRef
46.
OnaliS, KalafateliM, MajumdarA, WestbrookR, O'BeirneJ, LeandroG, et al. Non-selective beta-blockers are not associated with increased mortality in cirrhotic patients with ascites. Liver Int 2017.
47.
SinhaR, LockmanKA, MallawaarachchiN, RobertsonM, PlevrisJN, HayesPC. Carvedilol use is associated with improved survival in patients with liver cirrhosis and ascites. J Hepatol 2017.
48.
Bang UC, Benfield T, Hyldstrup L, Jensen JE, Bendtsen F. Effect of propranolol on survival in patients with decompensated cirrhosis: a nationwide study based Danish patient registers. Liver Int. 2016;36(9):1304–12.PubMedCrossRef
49.
•• Mookerjee RP, Pavesi M, Thomsen KL, Mehta G, Macnaughtan J, Bendtsen F, et al. Treatment with non-selective beta blockers is associated with reduced severity of systemic inflammation and improved survival of patients with acute-on-chronic liver failure. J Hepatol. 2016;64(3):574–82. This is the first study to show that nonselective beta blockers (NSBBs) are safe in the sickest of cirrhotic patients, those presenting with acute on chronic liver failure. This is one of many studies examining the relationship between NSBB and mortality in cirrhotic patients. PubMedCrossRef
50.
Heidelbaugh JJ, Kim AH, Chang R, Walker PC. Overutilization of proton-pump inhibitors: what the clinician needs to know. Ther Adv Gastroenterol. 2012;5(4):219–32.CrossRef
51.
Aseeri M, Schroeder T, Kramer J, Zackula R. Gastric acid suppression by proton pump inhibitors as a risk factor for clostridium difficile-associated diarrhea in hospitalized patients. Am J Gastroenterol. 2008;103(9):2308–13.PubMedCrossRef
52.
Laheij RJ, Sturkenboom MC, Hassing RJ, Dieleman J, Stricker BH, Jansen JB. Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. JAMA. 2004;292(16):1955–60.PubMedCrossRef
53.
Venkatesh PG, Parasa S, Njei B, Sanaka MR, Navaneethan U. Increased mortality with peptic ulcer bleeding in patients with both compensated and decompensated cirrhosis. Gastrointest Endosc. 2014;79(4):605–14. e3 PubMedCrossRef
54.
deMattosAZ, MiozzoSA, TovoCV, deMattosAA. Risks of proton pump inhibitors for cirrhotic patients—the controversy remains. Hepatology (Baltimore, Md). 2017.
55.
Bajaj JS, Zadvornova Y, Heuman DM, Hafeezullah M, Hoffmann RG, Sanyal AJ, et al. Association of proton pump inhibitor therapy with spontaneous bacterial peritonitis in cirrhotic patients with ascites. Am J Gastroenterol. 2009;104(5):1130–4.PubMedCrossRef
56.
Goel GA, Deshpande A, Lopez R, Hall GS, van Duin D, Carey WD. Increased rate of spontaneous bacterial peritonitis among cirrhotic patients receiving pharmacologic acid suppression. Clin Gastroenterol Hepatol. 2012;10(4):422–7.PubMedCrossRef
57.
O’Leary JG, Reddy KR, Wong F, Kamath PS, Patton HM, Biggins SW, et al. Long-term use of antibiotics and proton pump inhibitors predict development of infections in patients with cirrhosis. Clinical Gastroenterol Hepatol. 2015;13(4):753–9. e1-2CrossRef
58.
•• Terg R, Casciato P, Garbe C, Cartier M, Stieben T, Mendizabal M, et al. Proton pump inhibitor therapy does not increase the incidence of spontaneous bacterial peritonitis in cirrhosis: a multicenter prospective study. J Hepatol. 2015;62(5):1056–60. This was the first multicenter prospective study examining the association between PPI and the development of SBP. Given the ongoing controversy between PPI and SBP, this is an important study. Many of the studies reporting a negative association between PPI and SBP have been retrospective in nature. PubMedCrossRef
59.
Dam G, Vilstrup H, Watson H, Jepsen P. Proton pump inhibitors as a risk factor for hepatic encephalopathy and spontaneous bacterial peritonitis in patients with cirrhosis with ascites. Hepatology(Baltimore, Md). 2016;64(4):1265–72.PubMedCrossRef
60.
Khan MA, Kamal S, Khan S, Lee WM, Howden CW. Systematic review and meta-analysis of the possible association between pharmacological gastric acid suppression and spontaneous bacterial peritonitis. Eur J Gastroenterol Hepatol. 2015;27(11):1327–36.PubMedCrossRef
61.
Miozzo SA, Tovo CV, John JA, de Mattos AA. Proton pump inhibitor use and spontaneous bacterial peritonitis in cirrhosis: an undesirable association? J Hepatol. 2015;63(2):529–30.PubMedCrossRef
Metadaten
Titel
Current Trends in the Management of Spontaneous Bacterial Peritonitis
verfasst von
Chanda K. Ho
Sumeet K. Asrani
Publikationsdatum
19.07.2017
Verlag
Springer US
Erschienen in
Current Hepatology Reports / Ausgabe 3/2017
Elektronische ISSN: 2195-9595
DOI
https://doi.org/10.1007/s11901-017-0355-9

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