Short- and long-term predictors of spontaneous bacterial peritonitis in Singapore.
- Author:
Yu Jun WONG
1
;
Rajamanickam Chandrasekaran KALKI
1
;
Kenneth Weicong LIN
1
;
Rahul KUMAR
1
;
Jessica TAN
1
;
Eng Kiong TEO
1
;
James Weiquan LI
1
;
Tiing Leong ANG
1
Author Information
- Publication Type:Journal Article
- Keywords: nosocomial; predictors; spontaneous bacterial peritonitis; survival
- From:Singapore medical journal 2020;61(8):419-425
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:Spontaneous bacterial peritonitis (SBP) is the commonest complication of liver cirrhosis. Timely and appropriate treatment of SBP is crucial, particularly with the rising worldwide prevalence of multidrug-resistant organisms (MDROs). We aimed to investigate the clinical outcomes of SBP in Singapore.
METHODS:All cirrhotic patients with SBP diagnosed between January 2014 and December 2017 were included. Nosocomial SBP (N-SBP) was defined as SBP diagnosed more than 48 hours after hospitalisation. Clinical outcomes were analysed as categorical outcomes using univariate and multivariate analysis.
RESULTS:There were 33 patients with 39 episodes of SBP. Their mean age was 64.5 years and 69.7% were male. The commonest aetiology of cirrhosis was hepatitis B (27.3%). The Median Model for End-stage Liver Disease (MELD) score was 17; 33.3% had acute-on-chronic liver failure and 60.6% had septic shock at presentation. N-SBP occurred in 25.6% of SBP cases. N-SBP was more commonly associated with MDROs, previous antibiotic use in the past three months (p = 0.014) and longer length of stay (p = 0.011). The 30-day and 90-day mortality among SBP patients was 30.8% and 51.3%, respectively. MELD score > 20 was a predictor for 30-day mortality. N-SBP and MELD score > 20 were predictors for 90-day mortality.
CONCLUSION:N-SBP was significantly associated with recent antibiotic use, longer hospitalisation, more resistant organisms and poorer survival among patients with SBP. N-SBP and MELD score predict higher mortality in SBP. Judicious use of antibiotics may reduce N-SBP and improve survival among cirrhotic patients.
