الفهرس 
AbstractOnly 14 pages are availabe for public view
 |  | from | 220 |  |  |
| | | from | 220 | | |
Abstract
Bacterial and fungal infections constitute a major complication of cirrhosis. They account for 25%– 46% of hospitalizations due to acute decompensation events in cirrhotic patients and are associated with high morbidity and mortality. Hospital-acquired infections show higher levels of drug-resistant bacteria.
SBP is defined as an ascitic fluid infection without an evident intra-abdominal surgically treatable source. The presence of SBP, which almost always occurs in patients with cirrhosis and ascites, is suspected because of signs and symptoms such as fever, abdominal pain, or altered mental status. A PMN count of ≥ 250 cells/mm3 in the ascitic fluid, regardless of the isolation of bacteria from the fluid, is diagnostic for SBP, gram-negative bacilli cause it and to a lesser extent, gram-positive cocci.
Intestinal changes and a weak immune system in patients with liver cirrhosis lead to bacterial translocation, thus causing SBP. Early diagnosis and timely treatment are important in SBP management. Other rare pathogens should be explored when the treatment effect is not effective.
SFP is a fungal infection of ascitic fluid with no apparent intra-abdominal source of infection or malignancy. A PMN count of ≥ 250 cells/mm3 in the ascitic fluid with a positive fungal culture regardless of co-colonization of bacteria is diagnostic of SFP.
The rapid initiation of antifungal therapy in the presence of septic shock and failure to respond to broad-spectrum antibiotic regimens is necessary in SFP or suspected SFP cases.
Although early differentiation between SFP and SBP may be difficult partially because identifying fungi in cultures of ascitic fluid is time-consuming. The clinician should be able to suspect SFP or SBP due to MDR if spontaneous peritonitis is not improved after 48 h empirical antibiotic treatment. Therefore, new cultures in ascitic fluid and blood may be performed in these patients. Moreover, additional administration of antifungal agents and alternation of antibiotics may be considered in these patients.
High levels of antimicrobial drug resistance deleteriously affecting treatment outcome with antibacterial agents are causing increasing concern worldwide.
Antibiotics have to be started early before results of microbiological culture are available.
Multi-drug resistant organisms rates to quinolone drugs of up to 40% are recorded in patients with SBP with prophylactic antibiotics, leading to a break-through recurrence of intra-peritoneal infection.
Sixty patients with liver cirrhosis, ascites with ascitic fluid infection (SBP) (irrespective of the cause of admission) were enrolled in our study from Hepatology & Gastroenterology inpatient department, Beni-Suef University hospital in the period between October 2020 and June 2021 at the time of the peak of covid-19.
All patient were subjected to full history, clinical examination, routine laboratory investigations including complete blood picture, liver, kidney function tests and CRP. Together with the chemical, bacteriological and cytological examination of the ascitic fluid and CHILD score.
There was a statistically significant difference higher among patients with positive culture SBP than those with negative culture SBP regarding the prevalence of GIT bleeding, abdominal pain and abdominal tenderness. Also there was a statistically significant difference higher among patients with positive culture SBP than those with negative culture SBP regarding in laboratory investigation TLC, HB, platelet count and urea.
The results of our study showed the following; 39 patients (65%) developed culture-negative SBP and 21 patients (35%) developed culture-positive SBP, including 13 patient with gram-negative bacilli (21.7%) and 8 patients with gram-positive cocci (13.3%). The most common organisms was E-Coli in 11 patients (18.3%), Klebsiella in 1 patient (1.7%), Pseudomonas in 1 patient (1.7%), coagulase-negative Staphylococcus in 5 patients (8.3%), Enterococci in 2 patients (3.3%), Staphylococcus areus in 1 patient (1.7%), with no fungal finding.
In 35% positive culture SBP, the prevalence of MDROs was (42.7%) and reached (52.4 %) when adding (9.5%) XDROs. MDROs included 4 patients have resistant E-Coli (36.4%), 1 patient has resistant Enterococci (50%), 1 patient has resistant Pseudomonas (100%), 3 patients who have resistant Coagulase-negative staphylococcus with Multi drug-resistant organisms and 2 patients have resistant E-Coli with Extensively drug-resistant organisms.
We summarized finally that the prevalence of MDROs in cirrhotic patients reaches (52.4%). This is considered an important, complicated and growing problem as its rate is growing and the increase in antibiotic resistance makes worry to all world.