Aspectos microbiológicos de interés en el diagnóstico de la peritonitis bacteriana espontánea del paciente con cirrosis hepática
Palabras clave:
CIRROSIS HEPATICA, ASCITIS, INFECCIONES BACTERIANAS, PERITONITIS, PROFILAXIS ANTIBIÓTICA
Resumen
La peritonitis bacteriana espontánea es una complicación grave del paciente cirrótico, con elevada mortalidad intrahospitalaria y pobre pronóstico a corto plazo. Su diagnóstico requiere un elevado índice de sospecha, la realización precoz de paracentesis abdominal para recuento del número de polimorfonucleares en líquido de ascitis y estudio bacteriológico. El cultivo en frascos de hemocultivo ha sustituido al método tradicional en placa de agar por su mayor rendimiento diagnóstico y su menor demora. La importancia de los estudios bacteriológicos tiene un renovado interés debido a los cambios reportados en la literatura en la causa de la infección en relación al uso de antibioticoterapia profiláctica, al aumento de infecciones nosocomiales, y al bajo rendimiento del estudio directo del líquido de ascitis. Esta metodología de estudio del líquido de ascitis ha permitido mejorar el diagnóstico de peritonitis bacteriana espontánea en el Hospital Pasteur. En medios sanitarios de escasos recursos económicos, podría ser apropiado cultivar el líquido de ascitis de pacientes cirróticos en frascos de hemocultivo sólo en casos de sospecha clínica o analítica de peritonitis bacteriana espontánea, o de inicio de terapéutica antibiótica, disminuyendo así el costo asistencial en relación a esta técnica de cultivo microbiológica.
Citas
1) Rimola A, Bory F, Planas R, Xaubet A, Bruguera M, Rodes J. Infecciones bacterianas agudas en la cirrosis hepática. Gastroenterol Hepatol 1981; 18: 353-8.
2) Runyon BA. Spontaneous bacterial peritonitis associated with cardiac ascites. Am J Gastroenterol 1984; 79(10): 796.
3) Thomas FB, Fromkes JJ. Spontaneous bacterial peritonitis associated with acute viral hepatitis. J Clin Gastroenterol 1982; 4(3): 259-62.
4) Fernández J, Navasa M, Gómez J, Colmenero J, Vila J, Arroyo V, et al. Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology 2002; 35(1): 140-8.
5) Rimola A, García-Tsao G, Navasa M, Piddock LJ, Planas R, Bernard B, et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. J Hepatol 2000; 32(1): 142-53.
6) Hoefs JC, Canawati HN, Sapico FL, Hopkins RR, Weiner J, Montgomerie JZ. Spontaneous bacterial peritonitis. Hepatology 1982; 2(4): 339-402.
7) Caly WR, Strauss E. A prospective study of bacterial infections in patients with cirrhosis. J Hepatol 1993; 18(3): 353-8.
8) Hurwich DB, Lindor KD, Hay JE, Gross JB Jr, Kaese D, Rajela J. Prevalence of peritonitis and the ascitic fluid protein concentration among chronic liver disease patients. Am J Gastroenterol 1993; 88(8): 1254-7.
9) Such J, Guarner C, Runyon BA. Spontaneous bacterial peritonitis. In: Arroyo V, Ginès P, Rodés J, Schrier R (ed). Ascites and renal dysfunction in liver disease: pathogenesis, diagnosis, and treatment. Massachusetts: Blackwell Science, 1999: 99-115.
10) Rubinstein P, Morales M, Pandiani A, Bagattini JC. Peritonitis bacteriana espontánea en cirrosis hepática con ascitis: incidencia, bacteriología y mortalidad en Uruguay. Acta Gastroenterol Latinoam 2001; 31(4): 307-12.
11) Conn HO, Fessel JM. Spontaneous bacterial peritonitis and bacteriemia in cirrhotic patients caused by enteric bacteria. Ann Intern Med 1964; 60: 568-80.
12) García Tsao G, Conn HO, Lerner E. The diagnosis of bacterial peritonitis. Comparison of pH, lactate concentration and leukocyte count. Hepatology 1985; 5(1): 91-6.
13) Yang CY, Liaw YF, Chu CM, Sheen IS. White count, pH and lactate in the diagnosis of spontaneous bacterial peritonitis. Hepatology 1985; 5(1): 85-90.
14) Pinzello G, Virdone R, Lojacono F, Ciambra M, Dardanoni G, Fiorentino G, et al. Is the acidity of ascitic fluid a reliable index in making presumptive diagnosis of spontaneous bacterial peritonitis? Hepatology 1986; 6(2): 244-7.
15) Gitlin N, Stauffer JL, Silvestri RC. The pH of ascitic fluid in the diagnosis of spontaneous bacterial peritonitis. Hepatology 1982; 2(4): 408-11.
16) Runyon BA, Antillon MR. Ascitic fluid pH and lactate: insensitive and non-specific tests in detecting ascitic fluid infection. Hepatology 1991; 13(5): 929-35.
17) Albillos A, Cuervas-Mons V, Millán I, Canton T, Montes J, Barrios C, et al. Ascitic fluid polymorphonuclear cell count and serum to ascites albumin gradient in the diagnosis of bacterial peritonitis. Gastroenterology 1990; 98(1): 134-40.
18) Rimola A, Salmeron JM, Clemente G, Rodrigo L, Obrador A, Miranda ML, et al. Two different dosages of cefotaxime in the treatment of spontaneous bacterial peritonitis in cirrhosis: results of a prospective, randomized, multicenter study. Hepatology 1995; 21(3): 674-9.
19) Runyon BA, Canawati HN, Akriviadis EA. Optimization of ascitic fluid culture technique. Gastroenterology 1988; 95(5): 1351-5.
20) Runyon BA, Umland EJ, Merlin T. Innoculation of blood culture bottles with ascitic fluid. Improved detection of spontaneous bacterial peritonitis. Arch Intern Med 1987; 147(1): 73-5.
21) Castellote J, Xiol V, Verdaguer R, Ribes J, Guardiola J, Giménez A, et al. Comparison of two ascitic fluid culture methods in cirrhotic patients with spontaneous bacterial peritonitis. J Clin Microbiol 1990; 28: 2811-2.
22) Terg R, Levi D, López P, Rafaelli C, Rojter S, Abecasis R, et al. Analysis of clinical course and prognosis of culture-positive spontaneous bacterial peritonitis and neutrocytic ascites. Evidence of the same disease. Dig Dis Sci 1992; 37(10): 1499-504.
23) Runyon BA, Hoefs JC. Culture negative neutrocytic ascites: a variant of spontaneous bacterial peritonitis. Hepatology 1984; 4(6): 1209-11.
24) Runyon BA. Monomicrobial non-neutrocytic bacterascites: a variant of spontaneous bacterial peritonitis. Hepatology 1990; 12(4 Pt 1): 710-5.
25) Chu CM, Chang KY, Liaw YF. Prevalence and prognostic significance of bacterascites in cirrhosis with ascites. Dig Dis Sci 1995; 40(3): 561-5.
26) Akriviadis EA, Runyon BA. Utility of an algorithm in differentiating spontaneous from secondary bacterial peritonitis. Gastroenterology 1990; 98(1): 127-33.
27) Targan SR, Chaw AW, Guze LB. Role of anaerobic bacteria in spontaneous peritonitis of cirrhosis. Report of two cases and review of the literature. Am J Med 1977; 62(3): 397-403.
28) Runyon BA, Hoefs JC. Spontaneous versus secondary bacterial peritonitis. Differentiation by response of ascitic fluid neutrophil count to antimicrobial therapy. Arch Intern Med 1986; 146(8): 1563-5.
29) García-Tsao G, Lee FY, Barden GE, Cartun R, West AB. Bacterial translocation to mesenteric lymph nodes is increased in cirrhotic rats with ascites. Gastroenterology 1995; 108(6): 1835-41
30) Cirera I, Bauer TM, Navasa M, Vila J, Grande L, Taura P, et al. Bacterial translocation of enteric organisms in patients with cirrhosis. J Hepatol 2001; 34(1): 32-7.
31) Gines P, Rimola A, Planas R, Vargas V, Marco F, Almela M. Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: results of a double-blind, placebo-controlled trial. Hepatology 1990; 12(4 Pt 1): 716-24.
32) Grange JD, Roulot D, Pelletier G, Pariente EA, Denis J, Ink O, et al. Norfloxacin primary prophylaxis of bacterial infections in cirrhotic patients with ascites: a double-blind, randomized trial. J Hepatol 1998; 29(3): 430-6.
33) Novella MT, Solá R, Soriano G, Andreu M, Gana J, Ortiz J, et al. Continuous versus in patients prophylaxis of the first episode of spontaneous bacterial peritonitis with norfloxacin. Hepatology 1997; 25: 532-6.
34) Llovet JM, Rodríguez-Iglesias P, Moitinho E, Planas R, Bataller R, Navasa M, et al. Spontaneous bacterial peritonitis in patients with cirrhosis undergoing selective intestinal decontamination. A retrospective study of 229 spontaneous bacterial peritonitis episodes. J Hepatol 1997; 26(1): 88-95.
35) Castellote J, Xiol J, Rote R, Fernández G. Spontaneous bacterial peritonitis and empyema by Escherichia coli resistant to norfloxacin in a patient on selective intestinal decontamination with norfloxacin. J Hepatol 1994; 20(3): 436.
36) Aparicio JR, Such J, Pascual S, Arroyo A, Plazas J, Girona E, et al. Development of quinolone-resistant strains of Escherichia coli in stools of patients with cirrhosis undergoing norfloxacin prophylaxis: clinical consequences. J Hepatol 1999; 31(2): 277-83.
37) Ortiz J, Vila MC, Soriano G, Miñana J, Gana J, Mirelis B, et al. Infections caused by Escherichia coli resistant to norfloxacin in hospitalized cirrhotic patients. Hepatology 1999; 29(4): 1064-9.
38) Runyon BA, Umland EJ, Merlin T. Inoculation of blood culture bottles with ascitic fluid at the bedside markedly improves detection of spontaneous bacterial peritonitis. Arch Intern Med 1987; 147(1): 73-5.
39) Runyon BA, Antillon MR, Akriviadis EA, McHutchinson JG. Bedside inoculation of blood culture bottles with ascitic fluid is superior to delayed inoculation in the detection of spontaneous bacterial peritonitis. J Clin Microbiol 1990; 28(12): 2811-2.
40) Ortiz J, Soriano G, Coll P, Novella MT, Pericas R, Sabat M, et al. Early microbiologic diagnosis of spontaneous bacterial peritonitis with BacT/ALERT. J Hepatol 1997; 26(4): 839-44.
41) Rimola A, Bory F, Terés J, Pérez-Ayuso RM, Arroyo V, Rodés J. Oral non-absorbable antibiotics prevent infection in cirrhosis with gastrointestinal hemorrhage. Hepatology 1985; 5: 463-7.
42) Soriano G, Guarner C, Tomás, Villanueva C, Torras X, González D, et al. Norfloxacin prevents bacterial infection in cirrhotics with gastrointestinal hemorrhage. Gastroenterology 1992; 103(4): 1267-72.
2) Runyon BA. Spontaneous bacterial peritonitis associated with cardiac ascites. Am J Gastroenterol 1984; 79(10): 796.
3) Thomas FB, Fromkes JJ. Spontaneous bacterial peritonitis associated with acute viral hepatitis. J Clin Gastroenterol 1982; 4(3): 259-62.
4) Fernández J, Navasa M, Gómez J, Colmenero J, Vila J, Arroyo V, et al. Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology 2002; 35(1): 140-8.
5) Rimola A, García-Tsao G, Navasa M, Piddock LJ, Planas R, Bernard B, et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. J Hepatol 2000; 32(1): 142-53.
6) Hoefs JC, Canawati HN, Sapico FL, Hopkins RR, Weiner J, Montgomerie JZ. Spontaneous bacterial peritonitis. Hepatology 1982; 2(4): 339-402.
7) Caly WR, Strauss E. A prospective study of bacterial infections in patients with cirrhosis. J Hepatol 1993; 18(3): 353-8.
8) Hurwich DB, Lindor KD, Hay JE, Gross JB Jr, Kaese D, Rajela J. Prevalence of peritonitis and the ascitic fluid protein concentration among chronic liver disease patients. Am J Gastroenterol 1993; 88(8): 1254-7.
9) Such J, Guarner C, Runyon BA. Spontaneous bacterial peritonitis. In: Arroyo V, Ginès P, Rodés J, Schrier R (ed). Ascites and renal dysfunction in liver disease: pathogenesis, diagnosis, and treatment. Massachusetts: Blackwell Science, 1999: 99-115.
10) Rubinstein P, Morales M, Pandiani A, Bagattini JC. Peritonitis bacteriana espontánea en cirrosis hepática con ascitis: incidencia, bacteriología y mortalidad en Uruguay. Acta Gastroenterol Latinoam 2001; 31(4): 307-12.
11) Conn HO, Fessel JM. Spontaneous bacterial peritonitis and bacteriemia in cirrhotic patients caused by enteric bacteria. Ann Intern Med 1964; 60: 568-80.
12) García Tsao G, Conn HO, Lerner E. The diagnosis of bacterial peritonitis. Comparison of pH, lactate concentration and leukocyte count. Hepatology 1985; 5(1): 91-6.
13) Yang CY, Liaw YF, Chu CM, Sheen IS. White count, pH and lactate in the diagnosis of spontaneous bacterial peritonitis. Hepatology 1985; 5(1): 85-90.
14) Pinzello G, Virdone R, Lojacono F, Ciambra M, Dardanoni G, Fiorentino G, et al. Is the acidity of ascitic fluid a reliable index in making presumptive diagnosis of spontaneous bacterial peritonitis? Hepatology 1986; 6(2): 244-7.
15) Gitlin N, Stauffer JL, Silvestri RC. The pH of ascitic fluid in the diagnosis of spontaneous bacterial peritonitis. Hepatology 1982; 2(4): 408-11.
16) Runyon BA, Antillon MR. Ascitic fluid pH and lactate: insensitive and non-specific tests in detecting ascitic fluid infection. Hepatology 1991; 13(5): 929-35.
17) Albillos A, Cuervas-Mons V, Millán I, Canton T, Montes J, Barrios C, et al. Ascitic fluid polymorphonuclear cell count and serum to ascites albumin gradient in the diagnosis of bacterial peritonitis. Gastroenterology 1990; 98(1): 134-40.
18) Rimola A, Salmeron JM, Clemente G, Rodrigo L, Obrador A, Miranda ML, et al. Two different dosages of cefotaxime in the treatment of spontaneous bacterial peritonitis in cirrhosis: results of a prospective, randomized, multicenter study. Hepatology 1995; 21(3): 674-9.
19) Runyon BA, Canawati HN, Akriviadis EA. Optimization of ascitic fluid culture technique. Gastroenterology 1988; 95(5): 1351-5.
20) Runyon BA, Umland EJ, Merlin T. Innoculation of blood culture bottles with ascitic fluid. Improved detection of spontaneous bacterial peritonitis. Arch Intern Med 1987; 147(1): 73-5.
21) Castellote J, Xiol V, Verdaguer R, Ribes J, Guardiola J, Giménez A, et al. Comparison of two ascitic fluid culture methods in cirrhotic patients with spontaneous bacterial peritonitis. J Clin Microbiol 1990; 28: 2811-2.
22) Terg R, Levi D, López P, Rafaelli C, Rojter S, Abecasis R, et al. Analysis of clinical course and prognosis of culture-positive spontaneous bacterial peritonitis and neutrocytic ascites. Evidence of the same disease. Dig Dis Sci 1992; 37(10): 1499-504.
23) Runyon BA, Hoefs JC. Culture negative neutrocytic ascites: a variant of spontaneous bacterial peritonitis. Hepatology 1984; 4(6): 1209-11.
24) Runyon BA. Monomicrobial non-neutrocytic bacterascites: a variant of spontaneous bacterial peritonitis. Hepatology 1990; 12(4 Pt 1): 710-5.
25) Chu CM, Chang KY, Liaw YF. Prevalence and prognostic significance of bacterascites in cirrhosis with ascites. Dig Dis Sci 1995; 40(3): 561-5.
26) Akriviadis EA, Runyon BA. Utility of an algorithm in differentiating spontaneous from secondary bacterial peritonitis. Gastroenterology 1990; 98(1): 127-33.
27) Targan SR, Chaw AW, Guze LB. Role of anaerobic bacteria in spontaneous peritonitis of cirrhosis. Report of two cases and review of the literature. Am J Med 1977; 62(3): 397-403.
28) Runyon BA, Hoefs JC. Spontaneous versus secondary bacterial peritonitis. Differentiation by response of ascitic fluid neutrophil count to antimicrobial therapy. Arch Intern Med 1986; 146(8): 1563-5.
29) García-Tsao G, Lee FY, Barden GE, Cartun R, West AB. Bacterial translocation to mesenteric lymph nodes is increased in cirrhotic rats with ascites. Gastroenterology 1995; 108(6): 1835-41
30) Cirera I, Bauer TM, Navasa M, Vila J, Grande L, Taura P, et al. Bacterial translocation of enteric organisms in patients with cirrhosis. J Hepatol 2001; 34(1): 32-7.
31) Gines P, Rimola A, Planas R, Vargas V, Marco F, Almela M. Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: results of a double-blind, placebo-controlled trial. Hepatology 1990; 12(4 Pt 1): 716-24.
32) Grange JD, Roulot D, Pelletier G, Pariente EA, Denis J, Ink O, et al. Norfloxacin primary prophylaxis of bacterial infections in cirrhotic patients with ascites: a double-blind, randomized trial. J Hepatol 1998; 29(3): 430-6.
33) Novella MT, Solá R, Soriano G, Andreu M, Gana J, Ortiz J, et al. Continuous versus in patients prophylaxis of the first episode of spontaneous bacterial peritonitis with norfloxacin. Hepatology 1997; 25: 532-6.
34) Llovet JM, Rodríguez-Iglesias P, Moitinho E, Planas R, Bataller R, Navasa M, et al. Spontaneous bacterial peritonitis in patients with cirrhosis undergoing selective intestinal decontamination. A retrospective study of 229 spontaneous bacterial peritonitis episodes. J Hepatol 1997; 26(1): 88-95.
35) Castellote J, Xiol J, Rote R, Fernández G. Spontaneous bacterial peritonitis and empyema by Escherichia coli resistant to norfloxacin in a patient on selective intestinal decontamination with norfloxacin. J Hepatol 1994; 20(3): 436.
36) Aparicio JR, Such J, Pascual S, Arroyo A, Plazas J, Girona E, et al. Development of quinolone-resistant strains of Escherichia coli in stools of patients with cirrhosis undergoing norfloxacin prophylaxis: clinical consequences. J Hepatol 1999; 31(2): 277-83.
37) Ortiz J, Vila MC, Soriano G, Miñana J, Gana J, Mirelis B, et al. Infections caused by Escherichia coli resistant to norfloxacin in hospitalized cirrhotic patients. Hepatology 1999; 29(4): 1064-9.
38) Runyon BA, Umland EJ, Merlin T. Inoculation of blood culture bottles with ascitic fluid at the bedside markedly improves detection of spontaneous bacterial peritonitis. Arch Intern Med 1987; 147(1): 73-5.
39) Runyon BA, Antillon MR, Akriviadis EA, McHutchinson JG. Bedside inoculation of blood culture bottles with ascitic fluid is superior to delayed inoculation in the detection of spontaneous bacterial peritonitis. J Clin Microbiol 1990; 28(12): 2811-2.
40) Ortiz J, Soriano G, Coll P, Novella MT, Pericas R, Sabat M, et al. Early microbiologic diagnosis of spontaneous bacterial peritonitis with BacT/ALERT. J Hepatol 1997; 26(4): 839-44.
41) Rimola A, Bory F, Terés J, Pérez-Ayuso RM, Arroyo V, Rodés J. Oral non-absorbable antibiotics prevent infection in cirrhosis with gastrointestinal hemorrhage. Hepatology 1985; 5: 463-7.
42) Soriano G, Guarner C, Tomás, Villanueva C, Torras X, González D, et al. Norfloxacin prevents bacterial infection in cirrhotics with gastrointestinal hemorrhage. Gastroenterology 1992; 103(4): 1267-72.
Publicado
2002-12-31
Cómo citar
1.
Rubinstein Aguñín P, Bagattini JC. Aspectos microbiológicos de interés en el diagnóstico de la peritonitis bacteriana espontánea del paciente con cirrosis hepática. Rev. Méd. Urug. [Internet]. 31 de diciembre de 2002 [citado 17 de noviembre de 2024];18(3):225-9. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/964
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Trabajos de Revisión o Actualización y Puestas al día
