PERITONITA BACTERIANÃ SPONTANÃ: COMPLICAÞIE SEVERÃ A CIROZEI HEPATICE STUDIU PROSPECTIV

Spontaneous bacterial peritonitis (SBP) is a frequent and severecomplication of decompensated cirrhosis. SBP is defined as an infection of initially sterileascitic fluid (AF) without a detectable, surgically treatable source of infection. Aim: toevaluate the prevalence, incidence, pathogens and clinical outcome of patients with livercirrhosis and SBP. Methods: a prospective study evaluated 34 episodes of SBP developed in29 patients with cirrhosis and ascites admitted in hospital. SBP was diagnosed based on apolymorphonuclear cell count in ascitic fluid of >250 cells/mm3 in the absence of datacompatible with secondary peritonitis. Results: The mean age of the group was 56.89±8.79years, more frequently occurred in men 21 of 29 cases (72.41%). Microorganisms wereisolated in 12 episodes (35.29%): Gram-negative bacteria in 8 (66.67%) and Gram-positive in4 (33.33%). The first-line treatment failure and in-hospital mortality rates were 26.47% and17.64%, respectively. The low in-hospital mortality seems to be related to earlier diagnosis andtreatment. In the multivariate analysis, three significant independent predictive factors ofin-hospital mortality were identified: a high Model of End-Stage Liver Disease (MELD)score, renal failure and SBP caused by extended-spectrum â-lactamase-producing organisms.The relapse rate of PBS was 21.73%. Conclusions: SBP remains to be a serious complication,especially in patients with a high MELD score. Ceftazidim represents a good choice inempirical treatment of SBP.