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Predictive Factors of Spontaneous Bacterial Peritonitis Caused by Gram-Positive Bacteria in Patients With Cirrhosis

 Jung Ho Kim  ;  Yong Duk Jeon  ;  In Young Jung  ;  Mi Young Ahn  ;  Hea Won Ahn  ;  Jin Young Ahn  ;  Nam Su Ku  ;  Sang Hoon Han  ;  Jun Yong Choi  ;  Sang Hoon Ahn  ;  Young Goo Song  ;  Kwang Hyub Han  ;  June Myung Kim 
 MEDICINE, Vol.95(17) : 3489, 2016 
Journal Title
Issue Date
Aged ; Antibiotic Prophylaxis ; Carcinoma, Hepatocellular/diagnosis ; Carcinoma, Hepatocellular/microbiology ; Cohort Studies ; Comorbidity ; Female ; Gram-Negative Bacterial Infections/diagnosis ; Gram-Negative Bacterial Infections/microbiology ; Gram-Positive Bacterial Infections/diagnosis* ; Gram-Positive Bacterial Infections/microbiology* ; Gram-Positive Bacterial Infections/mortality ; Humans ; Liver Cirrhosis/diagnosis* ; Liver Cirrhosis/microbiology* ; Liver Cirrhosis/mortality ; Liver Function Tests ; Liver Neoplasms/diagnosis ; Liver Neoplasms/microbiology ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Organ Dysfunction Scores ; Peritonitis/diagnosis* ; Peritonitis/microbiology* ; Peritonitis/mortality ; Retrospective Studies ; Risk Factors ; Survival Rate
Spontaneous bacterial peritonitis (SBP) in patients with cirrhosis is typically caused by gram-negative bacteria. However, the number of SBP cases due to gram-positive bacteria is steadily increasing. To date, little is known about the predictive factors involved in SBP infections.We performed a retrospective cohort study of patients (>18 years) with SBP due to gram-positive and -negative bacteria who were enrolled from January 2006 to December 2013 at Severance Hospital in Seoul, Korea where the incidences of hepatitis B virus associated chronic liver disease, cirrhosis, and hepatocellular carcinoma are high. Only the 1st SBP episode for each patient within the study period was included in our analysis.We identified 77 patients with cirrhosis and SBP. Of these, 27 patients (35%) had gram-positive bacterial infections and 50 patients (65%) had gram-negative bacterial infections. Our univariate analysis revealed that an early stage of cirrhosis (P = 0.004), lower creatinine level (P = 0.011), lower Sequential Organ Failure Assessment (SOFA) score (P = 0.001), lower Model for End-Stage Liver Disease score (P = 0.005), and use of systemic antibiotics within 30 days before SBP diagnosis (P = 0.03) were significantly associated with gram-positive bacterial infections. Our multivariate analysis indicated that the use of systemic antibiotics within 30 days before SBP diagnosis (odds ratio, 3.94; 95% CI, 1.11-13.96; P = 0.033) and a lower SOFA score (odds ratio, 0.56; 95% CI, 0.37-0.86; P = 0.007) were independent predictive factors of SBP caused by gram-positive bacterial infections in patients with cirrhosis. However, we did not observe a statistically significant difference in the 28-day mortality between the gram-positive and -negative bacterial infection groups (40.7% vs 46.0%, respectively; P = 0.407).In this study, the incidence rate of SBP caused by gram-positive bacteria in patients with cirrhosis was similar to the rates reported in recently published studies. Furthermore, the use of systemic antibiotics within 30 days before SBP diagnosis and a lower SOFA score were significantly associated with SBP caused by gram-positive bacteria in patients with cirrhosis.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ku, Nam Su(구남수) ORCID logo https://orcid.org/0000-0002-9717-4327
Kim, Jung Ho(김정호) ORCID logo https://orcid.org/0000-0002-5033-3482
Kim, June Myung(김준명)
Song, Young Goo(송영구) ORCID logo https://orcid.org/0000-0002-0733-4156
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Choi, Jun Yong(최준용) ORCID logo https://orcid.org/0000-0002-2775-3315
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
Han, Sang Hoon(한상훈) ORCID logo https://orcid.org/0000-0002-4278-5198
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