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

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Abstract

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.

Original languageEnglish
Article numbere3489
JournalMedicine (United States)
Volume95
Issue number17
DOIs
Publication statusPublished - 2016 Apr 1

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Gram-Positive Bacteria
Peritonitis
Fibrosis
Gram-Positive Bacterial Infections
Organ Dysfunction Scores
Gram-Negative Bacterial Infections
Anti-Bacterial Agents
Gram-Negative Bacteria
Odds Ratio
End Stage Liver Disease
Incidence
Korea
Bacterial Infections
Hepatitis B virus
Liver Cirrhosis
Liver Diseases
Hepatocellular Carcinoma
Creatinine
Chronic Disease
Cohort Studies

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Kim, Jung Ho ; Jeon, Yong Duk ; Jung, In Young ; Ahn, Mi Young ; Ahn, Hea Won ; Ahn, Jin Young ; Ku, Nam Su ; Han, Sang Hoon ; Choi, Jun Yong ; Ahn, Sang Hoon ; Song, Young Goo ; Han, Kwang Hyub ; Kim, June Myung. / Predictive Factors of Spontaneous Bacterial Peritonitis Caused by Gram-Positive Bacteria in Patients with Cirrhosis. In: Medicine (United States). 2016 ; Vol. 95, No. 17.
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title = "Predictive Factors of Spontaneous Bacterial Peritonitis Caused by Gram-Positive Bacteria in Patients with Cirrhosis",
abstract = "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.",
author = "Kim, {Jung Ho} and Jeon, {Yong Duk} and Jung, {In Young} and Ahn, {Mi Young} and Ahn, {Hea Won} and Ahn, {Jin Young} and Ku, {Nam Su} and Han, {Sang Hoon} and Choi, {Jun Yong} and Ahn, {Sang Hoon} and Song, {Young Goo} and Han, {Kwang Hyub} and Kim, {June Myung}",
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Predictive Factors of Spontaneous Bacterial Peritonitis Caused by Gram-Positive Bacteria in Patients with Cirrhosis. / Kim, Jung Ho; Jeon, Yong Duk; Jung, In Young; Ahn, Mi Young; Ahn, Hea Won; Ahn, Jin Young; Ku, Nam Su; Han, Sang Hoon; Choi, Jun Yong; Ahn, Sang Hoon; Song, Young Goo; Han, Kwang Hyub; Kim, June Myung.

In: Medicine (United States), Vol. 95, No. 17, e3489, 01.04.2016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Predictive Factors of Spontaneous Bacterial Peritonitis Caused by Gram-Positive Bacteria in Patients with Cirrhosis

AU - Kim, Jung Ho

AU - Jeon, Yong Duk

AU - Jung, In Young

AU - Ahn, Mi Young

AU - Ahn, Hea Won

AU - Ahn, Jin Young

AU - Ku, Nam Su

AU - Han, Sang Hoon

AU - Choi, Jun Yong

AU - Ahn, Sang Hoon

AU - Song, Young Goo

AU - Han, Kwang Hyub

AU - Kim, June Myung

PY - 2016/4/1

Y1 - 2016/4/1

N2 - 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.

AB - 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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