Yonsei Med J.  2012 Mar;53(2):328-336. 10.3349/ymj.2012.53.2.328.

Spontaneous Bacterial Peritonitis in Patients with Hepatitis B Virus-Related Liver Cirrhosis: Community-Acquired versus Nosocomial

• Kim SU
• Chon YE
• Lee CK
• Park JY
• Kim DY
• Han KH
• Chon CY
• Kim S
• Jung KS
• Ahn SH

• KMID: 1120199
• DOI: http://doi.org/10.3349/ymj.2012.53.2.328

Abstract

PURPOSE
Spontaneous bacterial peritonitis (SBP) frequently develops in patients with liver cirrhosis; however, there is little data to suggest whether the acquisition site of infection influences the prognosis. This study compared the bacteriology, clinical characteristics and treatment outcomes of community-acquired SBP (CA-SBP) and nosocomial SBP (N-SBP).
MATERIALS AND METHODS
The medical records of 130 patients with hepatitis B virus (HBV)-related liver cirrhosis, who had experienced a first episode of SBP between January 1999 and December 2008, were reviewed.
RESULTS
The study population included 111 (85.4%) patients with CA-SBP and 19 (14.6%) patients with N-SBP. Baseline and microbiological characteristics as well as clinical course, including in-hospital mortality, did not differ between patients with CA-SBP and those with N-SBP (all p>0.05). The median survival time was 6.5 months, and 117 (90.0%) patients died during the follow-up period. Patients with CA-SBP and N-SBP survived for median periods of 6.6 and 6.2 months, respectively, without significant difference (p=0.569). Time to recurrence did not differ between patients with CA-SBP and N-SBP (4.7 vs. 3.6 months, p=0.925).
CONCLUSION
The acquisition site of infection did not affect clinical outcomes for patients with HBV-related liver cirrhosis who had experienced their first episode of SBP. Third-generation cephalosporins may be effective in empirically treating these patients, regardless of the acquisition site of the infection.

Keyword

Ascites; cirrhosis; community-acquired; nosocomial; spontaneous bacterial peritonitis

MeSH Terms

Community-Acquired Infections/etiology/*microbiology/mortality/virology
Female
Hepatitis B virus/*pathogenicity
Humans
Liver Cirrhosis/complications/mortality/*virology
Male
Middle Aged
Peritonitis/etiology/*microbiology/mortality/*virology
Retrospective Studies

Figure

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  Fig. 1 Cumulative recurrence-free curves of patients with CA-SBP and patients with N-SBP. Time to recurrence was not different between the groups [median 4.7 months (range, 0.8-29.5) vs. 3.6 months (range, 1.3-12.8), p=0.925]. CA-SBP, community acquired spontaneous bacterial peritonitis; N-SBP, nosocomial spontaneous bacterial peritonitis;

• 

  Fig. 2 Cumulative overall survival curves of patients with CA-SBP and patients with N-SBP. Overall survival was not different between the groups [median 6.6 months (range, 0.1-128.1) vs. 6.2 months (range, 0.2-136.1), p=0.569]. CA-SBP, community acquired spontaneous bacterial peritonitis; N-SBP, nosocomial spontaneous bacterial peritonitis;

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