Document Type : Original Article(s)
Authors
- Sara Salehi 1
- Naser Honar 2
- Gholamreza Pouladfar 3
- Marzieh Davoodi 4
- Hamid Reihani 5
- Mahmood Haghighat 6
- Mohammad Hadi Imanieh 6
- Seyed Mohsen Dehghani 6
- Maryam Ataollahi 6
- Narges Ansari-Charsoughi 6
- Iraj Shahramian 6
- Amin Abbasian 7
1 Department of Pediatrics, School of Medicine, Namazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
2 Department of Pediatrics Gastroenterology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
3 Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
4 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
5 Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
6 Department of Pediatrics Gastroenterology, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
7 Professor Alborzi Clinical Microbiology Research Center, Namazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
Background: Spontaneous bacterial peritonitis (SBP) is a fatal complication of ascites fluid infection. The causes of SBP in children differ from those in adults, and these bacteria are frequently resistant to antibiotics. Therefore, this study investigated the clinical findings, bacterial etiology, and antimicrobial resistance in children with SBP.
Methods: This study was conducted on all new pediatric ascites patients, who were admitted to the Department of Pediatric Gastroenterology, Namazi Hospital, affiliated with Shiraz University of Medical Sciences (Shiraz, Iran) from 2021 to 2022. Required data such as demographic information, and clinical information such as complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Gram staining, blood culture by Automated Blood Culture System (BACTEC), and antibiogram of ascites fluids by disc diffusion method were all collected. Finally, the data were statistically analyzed using SPSS Software (version 26). Besides, the t test, Fisher’s exact, Mann-Whitney, and Chi square tests were used for data analysis. In all tests, P≤0.05 was considered statistically significant.
Results: The present study examined 62 children with ascites of which 18 (29%) had SBP. The median (IQR) age was 2.5 (8.1) years. Thirty-four (54.8%) of the participants were girls. Abdominal pain was the most common clinical manifestation in patients (54%), and there was a significant association between abdominal pain and SBP (P=0.02). In 12 positive ascites fluid cultures, coagulase-negative staphylococci had the highest frequency (25%), followed by Escherichia coli (16.7%). Third-generation cephalosporins had a 25% sensitivity in the total positive cultures. This sensitivity was 33.3% for Gram-negative cultures and 16.6% for Gram-positive cultures.
Conclusion: Although third-generation cephalosporins are recommended as the primary antibiotic for the empirical treatment of SBP, the present study found high bacterial resistance. Finally, empirical therapy should be tailored to each region’s bacterial resistance features.
Keywords
- El-Hakim Allam AA, Eltaras SM, Hussin MH, Salama EI, Hendy OM, Allam MM, et al. Diagnosis of spontaneous bacterial peritonitis in children using leukocyte esterase reagent strips and granulocyte elastase immunoassay. Clin Exp Hepatol. 2018;4:247-52. doi: 10.5114/ceh.2018.80126. PubMed PMID: 30603672; PubMed Central PMCID: PMCPMC6311742.
- Tay PWL, Xiao J, Tan DJH, Ng C, Lye YN, Lim WH, et al. An Epidemiological Meta-Analysis on the Worldwide Prevalence, Resistance, and Outcomes of Spontaneous Bacterial Peritonitis in Cirrhosis. Front Med (Lausanne). 2021;8:693652. doi: 10.3389/fmed.2021.693652. PubMed PMID: 34422858; PubMed Central PMCID: PMCPMC8375592.
- Ghobrial C, Mogahed EA, El-Karaksy H. Routine analysis of ascitic fluid for evidence of infection in children with chronic liver disease: Is it mandatory? PLoS One. 2018;13:e0203808. doi: 10.1371/journal.pone.0203808. PubMed PMID: 30289914; PubMed Central PMCID: PMCPMC6173381.
- Honar N, Geramizadeh B, Dehghani SM, Kalvandi G, Shahramian I, Rahmani A, et al. Evaluation of Leukocyte Esterase Reagent Strips Test in the Diagnosis of Spontaneous Bacterial Peritonitis in Children with Cirrhosis. Arq Gastroenterol. 2015;52:195-9. doi: 10.1590/S0004-28032015000300008. PubMed PMID: 26486286.
- Farahmand F, Eshagh Roze M, Shams S, Ghajarzadeh M, Mohammadi B. Diagnosis of spontaneous bacterial peritonitis in children by reagent strips. Acta Med Iran. 2013;51:125-8. PubMed PMID: 23585320.
- Thiele GB, Silva OM, Fayad L, Lazzarotto C, Ferreira Mdo A, Marconcini ML, et al. Clinical and laboratorial features of spontaneous bacterial peritonitis in southern Brazil. Sao Paulo Med J. 2014;132:205-10. doi: 10.1590/1516-3180.2014.1324698. PubMed PMID: 25055065; PubMed Central PMCID: PMCPMC10496729.
- Duah A, Nkrumah KN. Spontaneous bacterial peritonitis among adult patients with ascites attending Korle-Bu Teaching Hospital. Ghana Med J. 2019;53:37-43. doi: 10.4314/gmj.v53i1.6. PubMed PMID: 31138942; PubMed Central PMCID: PMCPMC6527825.
- Piano S, Brocca A, Mareso S, Angeli P. Infections complicating cirrhosis. Liver Int. 2018;38:126-33. doi: 10.1111/liv.13645. PubMed PMID: 29427501.
- Marciano S, Diaz JM, Dirchwolf M, Gadano A. Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies. Hepat Med. 2019;11:13-22. doi: 10.2147/HMER.S164250. PubMed PMID: 30666172; PubMed Central PMCID: PMCPMC6336019.
- Garcia-Tsao G. Current Management of the Complications of Cirrhosis and Portal Hypertension: Variceal Hemorrhage, Ascites, and Spontaneous Bacterial Peritonitis. Dig Dis. 2016;34:382-6. doi: 10.1159/000444551. PubMed PMID: 27170392.
- Pouladfar G, Jafarpour Z, Hosseini SA, Janghorban P, Roozbeh J. Antibiotic selective pressure and development of bacterial resistance detected in bacteriuria following kidney transplantation. Transplant Proc. 2015;47:1131-5. doi: 10.1016/j.transproceed.2014.11.062. PubMed PMID: 26036537.
- Popoiag RE, Fierbinteanu-Braticevici C. Spontaneous bacterial peritonitis: update on diagnosis and treatment. Rom J Intern Med. 2021;59:345-50. doi: 10.2478/rjim-2021-0024. PubMed PMID: 34182617.
- Zhang G, Jazwinski Faust A. Spontaneous Bacterial Peritonitis. JAMA. 2021;325:1118. doi: 10.1001/jama.2020.10292. PubMed PMID: 33724324.
- Jiang Y, Fan C, Dang Y, Zhao W, Lv L, Lou J, et al. Clinical Characteristics and Early Diagnosis of Spontaneous Fungal Peritonitis/Fungiascites in Hospitalized Cirrhotic Patients with Ascites: A Case-Control Study. J Clin Med. 2023;12. doi: 10.3390/jcm12093100. PubMed PMID: 37176540; PubMed Central PMCID: PMCPMC10179646.
- Dehghani SM, Gholami S, Bahador A, Nikeghbalian S, Salahi H, Imanieh MH, et al. Morbidity and mortality of children with chronic liver diseases who were listed for liver transplantation in Iran. Pediatr Transplant. 2007;11:21-3. doi: 10.1111/j.1399-3046.2006.00619.x. PubMed PMID: 17239119
- Haghighat M, Dehghani SM, Alborzi A, Imanieh MH, Pourabbas B, Kalani M. Organisms causing spontaneous bacterial peritonitis in children with liver disease and ascites in Southern Iran. World J Gastroenterol. 2006;12:5890-2. doi: 10.3748/wjg.v12.i36.5890. PubMed PMID: 17007059; PubMed Central PMCID: PMCPMC4100674.
- El-Shabrawi MH, El-Sisi O, Okasha S, Isa M, Elmakarem SA, Eyada I, et al. Diagnosis of spontaneous bacterial peritonitis in infants and children with chronic liver disease: A cohort study. Ital J Pediatr. 2011;37:26. doi: 10.1186/1824-7288-37-26. PubMed PMID: 21599998; PubMed Central PMCID: PMCPMC3121671.
- Alexopoulou A, Papadopoulos N, Eliopoulos DG, Alexaki A, Tsiriga A, Toutouza M, et al. Increasing frequency of gram-positive cocci and gram-negative multidrug-resistant bacteria in spontaneous bacterial peritonitis. Liver Int. 2013;33:975-81. doi: 10.1111/liv.12152. PubMed PMID: 23522099.
- RM EL, Oda MS, Saeed MA, Ramadan RA. A comparative study on nosocomial and community-acquired spontaneous bacterial peritonitis in patients with liver cirrhosis at a university hospital. Eur J Gastroenterol Hepatol. 2022;34:655-63. doi: 10.1097/MEG.0000000000002328. PubMed PMID: 35352700.
- Singh SK, Poddar U, Mishra R, Srivastava A, Yachha SK. Ascitic fluid infection in children with liver disease: time to change empirical antibiotic policy. Hepatol Int. 2020;14:138-44. doi: 10.1007/s12072-019-09968-x. PubMed PMID: 31290071.
- Almeida PRL, Leao GS, Goncalves CDG, Picon RV, Tovo CV. Impact of Microbiological Changes on Spontaneous Bacterial Peritonitis in Three Different Periods over 17 Years. Arq Gastroenterol. 2018;55:23-7. doi: 10.1590/S0004-2803.201800000-08. PubMed PMID: 29561972.
- Wang SS. Epidemiology of Spontaneous Bacterial Peritonitis, Bacterial Species and Resistances. Cambridge: Harvard University; 2019.
- Angeloni S, Leboffe C, Parente A, Venditti M, Giordano A, Merli M, et al. Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice. World J Gastroenterol. 2008;14:2757-62. doi: 10.3748/wjg.14.2757. PubMed PMID: 18461661; PubMed Central PMCID: PMCPMC2709049.
- Li YT, Yu CB, Huang JR, Qin ZJ, Li LJ. Pathogen profile and drug resistance analysis of spontaneous peritonitis in cirrhotic patients. World J Gastroenterol. 2015;21:10409-17. doi: 10.3748/wjg.v21.i36.10409. PubMed PMID: 26420967; PubMed Central PMCID: PMCPMC4579887.
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