Prevalence and risk factors for spontaneous ascitic fluid infection in outpatient cirrhotics undergoing therapeutic paracentesis.

Pazhanivel, M (2010) Prevalence and risk factors for spontaneous ascitic fluid infection in outpatient cirrhotics undergoing therapeutic paracentesis. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION : Ascites is the most common complication of cirrhosis followed by hepatic encephalopathy and variceal hemorrhage. In the natural history of compensated cirrhosis, 50% of patients develop ascites during 10 years of follow up.1 It is the most common complication that leads to hospital admission. 15% of patients with ascites succumb in 1 year and 44% in 5 years. The major complications of ascites are refractory ascites, hepatorenal syndrome and spontaneous bacterial peritonitis. Patients with cirrhosis and ascites show a higher susceptibility to bacterial infections mainly because of the inadequate defense mechanisms. The most frequent infectious and severe complication that occurs is spontaneous bacterial peritonitis (25%), followed by urinary infections (20%), pneumonia (15%) and bacteremia (12%) Spontaneous bacterial peritonitis (SBP) is a potentially life-threatening complication in cirrhosis and has typically been described in hospitalized patients. The prevalence of SBP in hospitalized patients with decompensated cirrhosis is 10% - 30%. and 18% in those with hepatic encephalopathy. 8-9 One-third of patients with infected peritoneal fluid do not manifest overt signs or symptoms such as fever or abdominal pain at initial presentation.7 Also 7–27% of patients with cirrhotic ascites harbor occult peritoneal fluid infection at the time of hospital admission The incidence of spontaneous bacterial peritonitis in the outpatient setting is very low. Therapeutic paracentesis is the recommended treatment for patients with ascites that are resistant or refractory to other medical treatment. It also reduces the discomfort associated with tense ascites. It is usually done on an outpatient basis. The need for ascitic fluid cell count and cultures in asymptomatic cirrhotic patients following large-volume paracentesis (LVP) remains unclear. Although many of these patients are at increased risk for SBP due to their advanced liver disease, low protein ascites, and prior episodes of SBP, the need for routine ascitic fluid analysis in the outpatient setting remains unclear. AIM : The aim of this study was to determine the prevalence and risk factors for 1) Spontaneous bacterial peritonitis (SBP), 2) Monomicrobial non-neutrocytic bacterascites (MNB) and, 3) Culture-negative neutrocytic ascites (CNNA), in asymptomatic cirrhotic outpatients undergoing therapeutic paracentesis. CONCLUSION : In conclusion, the results of our study confirm that the prevalence of spontaneous bacterial peritonitis, monomicrobial bacterascites and culture negative non neutrocytic ascites in asymptomatic cirrhotic outpatients undergoing therapeutic paracentesis was very low. There were no significant risk factors predicting the occurrence of spontaneous infection of the ascitic fluid in outpatients. In our opinion, routine ascitic fluid analysis may be unnecessary in this clinical setting as it may not be cost effective. However testing the ascitic fluid only for cell count and differential in outpatient therapeutic paracenteses will ensure the clinician not to miss spontaneous ascitic fluid infection in the absence of clinical signs and symptoms. The criteria for diagnosis of spontaneous ascitic fluid infection as well as risk factors associated with it in outpatients without clinical or biological signs of infection need to be reassessed in larger randomized trials.

Item Type: Thesis (Masters)
Uncontrolled Keywords: spontaneous ascitic fluid infection ; outpatient ;cirrhotics ; therapeutic paracentesis ; Prevalence ; risk factors.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 13 Jul 2017 04:18
Last Modified: 13 Jul 2017 04:18

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