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Query: UMLS:C0341503 (bacterial peritonitis)
 1,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

At laparotomy, many surgeons routinely instill crystalloid solutions into the peritoneal cavity, presumably to dilute out necrotic debris, bacteria, and adjuvant substances which foster bacterial growth. We examined the effect on mortality, bacterial growth, clearance, and phagocytosis of various volumes of saline instilled into the peritoneal cavity of rats during Escherichia coli peritonitis. Minimal intraperitoneal bacterial growth was seen after the introduction of a nonlethal inoculum of viable E. coli in 1 ml of saline, while administration of an identical inoculum in 30 ml of saline intraperitoneally (i.p.) led to increased 48-hour mortality (p less than 0.01), and associated rapid bacterial proliferation (p less than 0.01). Clearance of nonviable radiolabelled E. coli from the peritoneal cavity was delayed, bacterial association with host peritoneal leukocytes was decreased, and blood uptake of radiolabelled bacteria was diminished in animals receiving 30 ml of saline i.p., compared to controls which received the identical inoculum in 1 ml of saline i.p. The clinical relevance of these studies is manifold: (1) they provide a possible explanation why patients with ascites due to cirrhosis or the nephrotic syndrome, or those patients undergoing peritoneal dialysis are more susceptible to primary and secondary bacterial peritonitis, possibly on the basis of impaired peritoneal clearance or diminished phagocytosis and, (2) although irrigation of the peritoneal cavity with crystalloid solution would seem prudent during laparotomy, these solutions must be removed prior to closure to prevent interference with normal peritoneal host defense mechanisms.
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PMID:The adjuvant effect of peritoneal fluid in experimental peritonitis. Mechanism and clinical implications. 636 82

Bacterial peritonitis in patients with cirrhosis has a wide variety of clinical presentations. We report a group of 21 cirrhotic patients with secondary peritonitis from intra-abdominal sources. Seven had infected ascites. All of them had unrecognized secondary peritonitis which was diagnosed and treated as spontaneous (primary) bacterial peritonitis (SBP). Ascitic fluid analysis yielded a mean white blood cell count of 23,750 +/- 10,935/cu mm with 91.5% polymorphonuclear leukocytes, significantly higher than patients surveyed with SBP, 1,757 +/- 2,154/cu mm (P less than .001). Ascitic fluid protein levels were also higher than those typically seen in SBP: 4.4 +/- 1.5 gm/dl vs 0.8 +/- 0.4 gm/dl (P less than .001). The ascites: serum protein ratio was consistent with an exudate in those patients with secondary peritonitis (0.7 +/- 0.2) in contrast to typically infected transudate in patients with SBP (0.15 +/- 0.05) (P less than .001). Bacteriologic determination was similar: single organisms with Escherichia coli the most common. Often the clinical features and ascitic fluid analysis will not differentiate spontaneous from secondary peritonitis. It is, therefore, clinically prudent to consider secondary bacterial peritonitis in cirrhotic patients, especially with ascitic fluid WBC counts in excess of 5,000/cu mm and protein levels of greater than or equal to 2.5 gm/dl. Noninvasive diagnostic procedures should be included to search for sources of intra-abdominal infection.
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PMID:Secondary bacterial peritonitis in cirrhotic patients with ascites. 637 7

A patient who developed fatal spontaneous bacterial peritonitis associated with cardiac ascites is reported. Spontaneous bacterial peritonitis most frequently occurs in patients with decompensated cirrhosis of alcoholic or nonalcoholic type. Although there are reports of spontaneous bacterial peritonitis occurring in patients with nephrotic syndrome, or with acute or chronic hepatitis, there appear to be no reports of spontaneous bacterial infection developing in cardiac ascites.
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PMID:Spontaneous bacterial peritonitis associated with cardiac ascites. 648 15

Cirrhotic patients with ascites are highly susceptible to spontaneous bacterial peritonitis. Patients with ascites due to causes other than cirrhosis very seldom develop peritonitis. The antibacterial activity of these ascitic fluids is not known. The present study was undertaken to evaluate the bactericidal and opsonic activity in ascitic fluid from patients with and without cirrhosis and in normal (nonascitic) peritoneal fluid. Normal peritoneal fluids of 20 control subjects and ascitic fluids of 22 patients with noncirrhotic ascites all had normal bactericidal activity. The bactericidal activity of ascitic fluid was diminished in all 25 patients with cirrhosis (P less than 0.00005 by Fisher's exact test). Similar results were found when opsonic activity was evaluated. Complement and immunoglobulin concentrations in cirrhotic ascites were significantly lower than those in the other two groups. The present study demonstrates that noncirrhotic ascitic fluid has antibacterial activity similar to normal peritoneal fluid, whereas cirrhotic ascitic fluid has a marked reduction of both bactericidal and opsonic activities. These defects may explain the high incidence of peritonitis in cirrhotic patients.
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PMID:Bactericidal and opsonic activity of ascitic fluid from cirrhotic and noncirrhotic patients. 685 61

A three year old child with cirrhosis of the liver and ascites caused by alpha-1-antitrypsin deficiency, developed severe abdominal pain with diarrhea and fever. Spontaneous bacterial peritonitis was diagnosed by demonstrating a purulent ascitic fluid with gram-positive cocci in the smear which were identified as pneumococci in the bacterial culture. The peritonitis subsided under antibiotic treatment without complications. Spontaneous bacterial peritonitis in children with cirrhosis of the liver is mentioned in the literature, but up to now, however, only three cases were reported in detail. In order to establish the diagnosis, abdominal tap should be tried rather than explorative laparotomy, the demonstration of gram-positive cocci is diagnostic of spontaneous bacterial peritonitis. With early antibiotic therapy, prognosis of the disease is favourable. Newborns and children with nephrotic syndrome, however, are particularly at risk.
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PMID:[Spontaneous bacterial peritonitis in cirrhosis of the liver caused by alpha-1-antitrypsin deficiency (author's transl)]. 698 Oct 63

Forty-three patients with spontaneous bacterial peritonitis (SBP) between 1973 and 1978 were identified. Criteria for SBP included a positive ascites culture and polymorphonuclear cell concentration greater than 250 cells per mm3. Chronic liver disease was documented by varices in 91%, severe histologic fibrosis or cirrhosis in 94%, splenomegaly in 91%, and past hospitalization for liver disease in 57% of the patients. SBP was detected within 7 days of admission in 17 patients (40%) and within 35 days in 38 patients. Single organisms were isolated from 38 patients and multiple organisms from 5 patients. Twenty-six of 43 patients survived the episode of SBP, but only 13 survived the hospitalization. Analysis of the survival curve from the onset of SBP revealed a rapid death rate and a slow death rate set of patients. Rapid death (less than or equal to 7 days from SBP onset) correlated with a lack of prior hospitalization for liver disease (p less than 0.001), hepatomegaly (p less than 0.001), increased serum bilirubin (p less than 0.005), serum creatinine (p less than 0.05), and peripheral white blood cell concentrations (p less than 0.05). Survival during hospitalization was associated with prior hospitalization with liver disease (p less than 0.001) and chills during the episode of SBP (p less than 0.001). The 43 patients were divided into Group 1 patients on the basis of a serum bilirubin greater than 8 mg% and/or serum creatinine greater than 2.1 mg%; Group 2 patients had lower values. Survival was greater in Group 2 patients with advanced, relatively quiescent liver disease compared to Group 1 patients for both the episode of SBP (91 vs. 29%; p less than 0.001) and for hospitalization (50 vs. 9%; p less than 0.05). Death in Group 2 patients was related to inadequate antibiotic therapy (p less than 0.05), nonhepatic factors, and new onset of renal failure. Although SBP in the setting of severe acute liver injury has a dismal prognosis, SBP with minimal acute liver injury has a relatively good prognosis for hospital survival even with advanced chronic liver disease. Long-term survival is also possible since 4 of 9 patients with prolonged follow-up have survived 3 years.
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PMID:Spontaneous bacterial peritonitis. 709 41

Thirty-six patients were referred to the Liver Unit between 1971 and 1980 after unsuspected liver disease had been found at laparotomy. The preoperative diagnosis had been extrahepatic biliary obstruction in 16 patients and intra-abdominal malignancy in 15. Misdiagnosis resulted from insufficient attention to the history and physical signs in 31 patients and omission or misinterpretation of liver function tests and of other hepatobiliary investigations in the remaining 5 patients. The morbidity and mortality of the 36 patients within 1 month of operation was 61 per cent and 31 per cent respectively. All patients with viral or alcoholic hepatitis died, and severe complications, which included bacterial peritonitis, wound dehiscence and hepatic failure, developed in 13 of 15 in whom ascites due to cirrhosis or the Budd-Chiari syndrome was present before operation.
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PMID:Adverse effects of exploratory laparotomy in patients with unsuspected liver disease. 710 30

Arizona hinshawii, a gram-negative enteric pathogen, causes serious infections in fowl, reptiles, and other animals. In humans, gastroenteritis, enteric fever, septicemia, and localized infections due to Arizona have occurred. There are no previous reports of spontaneous bacterial peritonitis secondary to Arizona, however. We report here a case of spontaneous bacterial peritonitis due to Arizona occurring in a patient with cirrhosis of the alcoholic type. The patient was treated with a 10-day course of gentamicin, and although she improved clinically, Arizona was cultured from the blood and bile postmortem.
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PMID:Spontaneous Arizona hinshawii peritonitis in cirrhosis with ascites. 723 42

Listeria monocytogenes has been increasingly implicated in spontaneous bacterial peritonitis in patients with cirrhosis. This bacterium can be mistaken for diphtheroids and gram-positive cocci if special attention is not paid to the motility pattern and specific biochemical tests. Although the sensitivity of ascitic fluid Gram stain is low, we describe a case in which the Gram stain of the ascites fluid was positive. This issue is now pertinent given recent recommendations of third-generation cephalosporin antibiotics as empiric therapy for spontaneous bacterial peritonitis; Listeria is resistant to cephalosporin agents. A positive Gram stain could affect the empiric antibiotic therapy. We review the clinical presentation and outcome in nine other cases of Listeria peritonitis occurring in cirrhotic patients.
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PMID:Listeria monocytogenes peritonitis in cirrhotic patients. Value of ascitic fluid gram stain and a review of literature. 782 Nov 23

We investigated 37 patients with ascites and liver cirrhosis in order to examine whether on the basis of correlation of cytokines and acute phase proteins of the ascitic fluid, prognosis of spontaneous bacterial peritonitis can be made. Significantly enhanced levels of interleukin-6, as well as acute phase reactants alpha-1-antitrypsin and C-reactive protein were found in the ascitic fluid of patients with spontaneous bacterial peritonitis. The levels of tumour necrosis factor alpha (TNF-alpha), neopterin, interleukin 2-receptor and granulocyte-macrophage colony stimulating factor were higher in patients with spontaneous bacterial peritonitis, but without statistical significance, whereas no differences were found between the interferon gamma, interleukin-2 and interleukin-1 levels. In addition, interleukin-6, TNF-alpha and neopterin levels were found to correlate significantly with the outcome of the disease. These findings show that acute phase reaction occurs in the ascitic compartment in correlation with the development of spontaneous bacterial peritonitis.
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PMID:Spontaneous bacterial peritonitis is associated with high levels of interleukin-6 and its secondary mediators in ascitic fluid. 751 36


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