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

To investigate the long-term probability of the appearance of the first episode of spontaneous bacterial peritonitis in cirrhosis with ascites and to identify predictors of this complication, we closely followed throughout their illness 127 patients consecutively admitted to our unit for the treatment of an episode of ascites without prior spontaneous bacterial peritonitis (follow-up period: 21 +/- 22 mo). Thirteen patients (10%) had the first spontaneous bacterial peritonitis episode during follow-up. The appearance probability of this complication is 11% at 1 yr and 15% at 3 yr. Thirty-three variables obtained at admission (including clinical data, standard liver and kidney function test results, ascitic fluid protein concentrations and hemodynamic parameters) were analyzed in relation to their value in predicting spontaneous bacterial peritonitis development. In univariate analysis (Kaplan-Meier curves) five variables reached statistical significance (p less than 0.05) as predictive factors for the development of the first spontaneous bacterial peritonitis episode. These five variables were poor nutritional status, increased serum bilirubin levels, increased serum AST levels, decreased prothrombin activity and reduced total protein concentration in ascitic fluid. When these five variables were introduced in a multivariate analysis, only the ascitic fluid protein concentration was found to correlate independently with spontaneous bacterial peritonitis development (p = 0.002). The probability of first spontaneous bacterial peritonitis after 3 yr of follow-up was 24% and 4% in patients with ascitic fluid protein content lower than 1 gm/dl and greater than or equal to 1 gm/dl, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Incidence and predictive factors of first episode of spontaneous bacterial peritonitis in cirrhosis with ascites: relevance of ascitic fluid protein concentration. 150 16

We present data on 10 patients (5 men and 5 women, aged 21-56 yrs) with end-stage liver disease or tumour who underwent orthotopic liver transplantation at Groote Schuur Hospital between October 1988 and June 1991. Standard surgical techniques were used for procuring the donor liver, the recipient hepatectomy and the implantation of the liver. The venovenous bypass method was used in all but 2 patients. Postoperative immunosuppression was usually achieved with cyclosporin, azathioprine and low-dose steroids. Six patients were treated with prophylactic OKT3. Rejection episodes were treated with bolus doses of intravenous steroids. The indications for liver transplantation included chronic active hepatitis progressing to cirrhosis (5), biliary cirrhosis in association with inflammatory bowel disease (1), sclerosing cholangitis (2), alpha 1-antitrypsin deficiency (1), and tumour (1). All patients with chronic liver disease had experienced at least one complication, examples of which included encephalopathy, bacterial peritonitis, ascites, variceal bleeding and septicaemia. Serious postoperative complications included acute rejection of the transplanted liver, renal and liver failure that responded to intensive care support and medical management. One patient died on the 11th postoperative day with complications of bleeding oesophageal ulcer, shock and fungaemia. The remaining patients are alive and well 1-31 months after transplantation.
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PMID:Orthotopic liver transplantation at Groote Schuur Hospital. 150 34

The past decade has seen the introduction of a number of new potent antimicrobial agents, including broad-spectrum beta-lactam compounds such as the ureidopenicillins, third-generation cephalosporins, carbapenems, and monobactams; combinations of penicillins with inhibitors of beta-lactamase; and the quinolones. Most of these agents have excellent activity against enteric gram-negative rods and some are active against anaerobic organisms, the two bacterial groups most likely to be encountered in gastrointestinal infections. Despite the potency and wide spectrum of many of these new agents, there are currently relatively few clinical situations in which any of the newer antimicrobials are the first-line agents for therapy or prophylaxis of gastrointestinal diseases. Reluctance to use these agents as first-line therapy is based on concerns about the selection and spread of resistant organisms, superinfection syndromes, and the high cost of many of the newer agents. Specific clinical settings in which these agents may be given preference are as follows: 1. use of a third-generation cephalosporin (cefotaxime or ceftriaxone) in the treatment of spontaneous bacterial peritonitis. 2. use of broad-spectrum beta-lactam compounds to provide gram-negative coverage in patients who should not receive aminoglycosides 3. use of a third-generation cephalosporin (ceftriaxone) in the treatment of central nervous system relapses of Whipple's disease 4. use of quinolones for the empiric treatment of suspected bacterial diarrhea in patients sufficiently ill to require empiric initiation of antibiotics. 5. use of quinolones for the treatment of chronic carriers of Salmonella typhi 6. use of norfloxacin for prophylaxis against SBP. As further experience with these new antimicrobial agents is obtained and as more bacteria develop resistance to current first-line agents, there can be little doubt that these new antibiotics will play an increasing role in the prevention and treatment of gastrointestinal disease.
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PMID:The role of newer antibiotics in gastroenterology. 151 60

Interleukin-1 (IL-1) is an inflammatory mediator with a variety of described physiologic functions. IL-1 alpha has been shown to confer a survival advantage to experimental animals when administered before a lethal bacterial challenge. The experiments reported here were performed to define the effective pretreatment interval of a single intravenous dose of IL-1 alpha in a murine model of bacterial peritonitis, to examine the differential induction of cytokines in animals with and without IL-1 alpha pretreatment, and to assess differences in histologic evidence of end organ damage. IL-1 alpha (27 micrograms/kg iv) conferred a survival advantage to mice given a lethal challenge of live Escherichia coli (2 x 10(8) CFU/mouse ip) when the pretreatment was given 2 to 24 hr before the bacterial inoculum. Longer pretreatment intervals were not significantly protective. Treatment with IL-1 alpha at 1 hr after bacterial inoculum also did not improve survival. Mice pretreated with IL-1 alpha developed significantly lower peak serum levels of TNF-alpha after E. coli injection than did control mice. Pretreated and control mice had similar peak serum levels of IL-6 after bacterial challenge; however, IL-1 alpha-pretreated mice had a less prolonged elevation of serum levels of IL-6. IL-1 alpha-pretreated animals were protected from the histologic evidence of end organ damage seen in control animals. Thus, in this model of E. coli peritonitis pretreatment with a single intravenous dose of IL-1 alpha confers a significant protective effect when given within a limited time range. Treatment outside this interval has no apparent beneficial effect.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Interleukin-1 alpha prevention of the lethality of Escherichia coli peritonitis. 152 30

Ascites is a late and uncommon symptom of Chronic Granulomatous Disease (CGD) of childhood following liver damage with portal hypertension due to hepatic granulomatosis. The Authors describe two patients with CGD, in whom ascites was the main symptom in the first case and the initial symptom in the second case. Ascites in these cases was not due to liver fibrosis but it was a consequence of primary bacterial peritonitis.
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PMID:[Ascites as an unusual manifestation of chronic granulomatous disease in childhood]. 152 2

The conventional method of ascitic fluid culturing was compared with the bedside inoculation of ascites into blood culture bottles and into lysis-centrifugation tubes. The conventional culture method was compared with the blood culture bottle method in 31 episodes of spontaneous bacterial peritonitis (SBP). Cultures were positive with the conventional culture method in 11 (35%) episodes and with the blood culture bottle method in 26 (84%) episodes (P less than 0.001). The lysis-centrifugation tube method was compared with the blood culture bottle method in 24 episodes of SBP. Cultures were positive with the lysis-centrifugation tube method in 11 (46%) episodes and with the blood culture bottle method in 19 (79%) episodes (P less than 0.05). Moreover, the blood culture bottle method also shortened the time needed for the detection of bacterial growth. In conclusion, bedside inoculation of ascites into blood culture bottles should be used routinely for patients with suspected SBP. Culturing of ascites in lysis-centrifugation tubes is more laborious than and inferior to that in blood culture bottles.
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PMID:Blood culture bottles are superior to lysis-centrifugation tubes for bacteriological diagnosis of spontaneous bacterial peritonitis. 155 84

We describe five patients with spontaneous bacterial peritonitis. The condition is reported more frequently than before and survival has improved. Important clinical features are increasing ascites and unexpected derangement of liver function. Possible predisposing factors, as well as diagnostic and therapeutic measures, are discussed. We emphasize the significance of ascitic polymorph nuclear cell count and bedside inoculation of ascites on blood culture medium, and stress the importance of prompt antibiotic therapy. The choice of empiric antimicrobial treatment is based on the reported frequency of causative agent and toxicity to drugs. Our experience so far indicates that cefotaxime administered as monotherapy is safe and efficient in these patients. Aminoglycosides should be avoided because of increased nephrotoxicity in patients with liver failure.
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PMID:[Spontaneous bacterial peritonitis]. 156 47

To investigate the possibility that low complement concentrations in the plasma and ascites of patients with severe liver disease could be secondary to complement consumption, complement activation was studied in 32 patients with severe liver disease, 11 of whom had spontaneous bacterial peritonitis (SBP). In patients with SBP, plasma C3 and C4 were significantly lower than in uninfected patients (mean values 0.74 v 1.13 g/l, p less than 0.01 and 0.20 v 0.28 g/l, p less than 0.05 respectively). Plasma complement activation via the classical pathway, as shown by C4d/C4, was significantly increased in patients with SBP compared with uninfected patients (37.3 v 22.2, p less than 0.01) as was C3d/C3 (14.0 v 8.11, p less than 0.01), but there was no significant difference in Ba/B between SBP and uninfected patients. Ascitic C3 concentrations were higher in patients without SBP than in infected patients (0.37 v 0.08 g/l, p less than 0.05), as were factor B values (0.11 v 0.03 g/l, p less than 0.05). There was no significant difference in ascitic C4 concentrations in patients with SBP compared with uninfected patients (0.03 v 0.07 g/l). Although consumption of C3, as shown by C3d/C3 in ascites, was increased in infected patients compared with uninfected patients (79.1 v 36.1, p less than 0.05), there was no difference in ascitic complement activation between the groups for either the classical or alternative pathways. In SBP, decreased plasma C3 and C4 are primarily caused by increased activation of the classical pathway and not impaired hepatic synthesis. Activation and consumption of C3 is one factor causing the low ascitic C3 concentrations observed in SBP.
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PMID:Activation of the classical complement pathway in spontaneous bacterial peritonitis. 156 47

The prevalence and prognostic significance of spontaneous bacterial peritonitis were prospectively studied in a series of 82 acute hepatitis patients decompensated with ascites. The in-hospital prevalence of spontaneous bacterial peritonitis was 31.7% (26 of 82 patients). Twenty cases were culture positive, including one with multiple isolates, and six cases were culture negative. E. coli and Klebsiella pneumoniae were the most common pathogens, accounting for 71.4% (15 of 21) of the total isolates, whereas only 9.5% were gram-positive organisms. No significant difference in the age, sex, cause of acute hepatitis, liver biochemistry, prothrombin time and ascites fluid concentration of total protein was noted between patients with spontaneous bacterial peritonitis and those without spontaneous bacterial peritonitis, except that bacteremia was recognized significantly more frequently in the former (57.7% or 15 of 26 patients) than in the latter (25.0% or 14 of 56 patients, p less than 0.005). In addition, patients with spontaneous bacterial peritonitis, when compared with those without spontaneous bacterial peritonitis, were more likely to have kidney failure (57.7% vs. 30.4%, p less than 0.05) and had a significantly higher mortality rate (73.1% vs. 39.3%, p less than 0.01). Among patients without spontaneous bacterial peritonitis, the prevalence of kidney failure and gastrointestinal hemorrhage and the mortality rate in patients with bacteremia (57.1%, 64.3% and 71.4%, respectively) were significantly higher than in those without bacteremia (21.4%, 19.0% and 28.6%, respectively; p less than 0.05, p less than 0.01 and p less than 0.01, respectively). In conclusion, 31.7% of severe acute hepatitis patients with ascites were recognized as having spontaneous bacterial peritonitis; the other 17.1% had bacteremia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The prevalence and prognostic significance of spontaneous bacterial peritonitis in severe acute hepatitis with ascites. 156 20

To evaluate the efficacy of peritoneal dialysis (PD) in the management of post-traumatic renal failure, the authors reviewed the courses of five critically injured patients treated with PD over an 18-month period. Each patient had a double-cuffed PD catheter inserted through a subcutaneous tunnel with PD initiated within 48 hours. The dialysis prescription was individualized for each patient with frequent exchanges performed using either a manual manifold system or a continuous cycling machine. Three of the five patients survived and none of the survivors required dialytic therapy at discharge. Duration of PD ranged from 10 to 57 days. Three patients required intermittent hemodialysis (HD) due to progressive azotemia and hyperkalemia. Two patients developed bacterial peritonitis and three patients developed hyperglycemia with PD continuing without interruption in each patient. When compared to HD, PD offers the advantages of better hemodynamic tolerance, no anticoagulation, no vascular access, and a reduced personnel requirement if continuous cyclic PD is used.
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PMID:Management of post-traumatic acute renal failure with peritoneal dialysis. 159 40


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