SPONTANEOUS ASCITIC INFECTION IN DIFFERENT CIRRHOTIC GROUPS - PREVALENCE, RISK-FACTORS AND THE EFFICACY OF CEFOTAXIME THERAPY

Objective: To investigate the prevalence of spontaneous ascitic infect ion (SAI) in different cirrhotic groups, the risk factors for developm ent of SAI, and the efficacy of cefotaxime therapy. Design: A prospect ive study. Setting: In-patient clinic of a university hospital. Patien ts: Eighty cirrhotic patients with ascites were assigned to four group s: hepatitis B or D virus-related 34, alcoholic 18, hepatitis C virus- related 14, miscellaneous 14. Interventions: Paracentesis was performe d on 80 patients during 92 consecutive hospitalizations. Ascitic fluid was cultured by the method of bedside inoculation of blood culture bo ttles with ascites. The patients with SAI were treated with cefotaxime (2 g, three times daily, intravenously) for 5 days. Main outcome meas ures: Frequency of SAI in cirrhotic groups; clinical, bacteriological and biochemical findings of SAI; rate of recovery from infection. Resu lts: Twenty SAI episodes (22%) were found in 16 patients; 8 episodes w ere spontaneous bacterial peritonitis, 2 bacterascites, and 10 culture -negative neutrocytic ascites. SAI occurred more frequently in patient s with hepatitis B or D virus-related liver cirrhosis (32%) than in th e alcoholic (6%, P < 0.05), hepatitis C virus-related (14%) or miscell aneous (14%) cirrhotic groups. In multivariate analysis, independent p redictive factors associated with the development of SAI are chronic h epatitis 8 virus infection, ascitic fluid total protein and serum bili rubin. Escherichia coli was obtained in 5 of 10 positive ascitic fluid cultures. Cure of the infection was achieved in 95% of episodes. Hosp italization mortality rate in infected patients was 20%. Conclusion: S pontaneous ascitic infection occurs in approximately 20% of cirrhotic patients hospitalized with ascites. The patients with low ascitic prot ein concentration, high serum bilirubin level or hepatitis B virus cir rhosis are more predisposed to SAI. Cefotaxime may be an effective fir st-choice antibiotic for ascitic fluid infection.