Articles Vol. 67 No. 7 26/07/2026

CLINICAL CHARACTERISTICS, PATHOGENS AND ANTIMICROBIAL SUSCEPTIBILITY OF SPONTANEOUS BACTERIAL PERITONITIS IN CIRRHOTIC PATIENTS AT THE HOSPITAL FOR TROPICAL DISEASES DURING 2022 – 2024

Dao Nguyen Bao Tran1,2, Le Manh Hung1,2, Pham Tran Dieu Hien3,4, Dao Bach Khoa1,2, Tran Le Hang Nga1,2, Phan Ngoc Phuong Thao3,4, Ho Dang Trung Nghia1,2,3,4
1 Hospital for Tropical Diseases
2 Bệnh viện Bệnh Nhiệt đới
3 Pham Ngoc Thach University of Medicine
4 Trường Đại học Y khoa Phạm Ngọc Thạch
DOI: 10.52163/yhc.v67i7.5904
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Keywords
infection, spontaneous bacterial peritonitis, cirrhosis, Escherichia coli.
Abstract

Objectives: This study aimed to describe the clinical, paraclinical characteristics, pathogens, antimicrobial susceptibility of spontaneous bacterial peritonitis in cirrhotic patients.

Methods: A descriptive case-series study was conducted on spontaneous bacterial peritonitis patients with cirrhosis upper 16 years old who were treated at the hospital for Tropical Diseases between January 2022 to August 2024.

Results: Fever ≥ 38oC was  in 64.6% of patients, followed by abdominal pain (74.6%); 10.5% of patients presented with neither fever nor abdominal pain; 71,8% of patients had white blood cells <12 000/mm3. Ascitic fluid cultures were positive in 58.9% of cases, of which over 90% of the isolates were Gram-negative bacteria. Escherichia coli were found to be the predominant agent isolated from the ascitic fluid infections (55%) followed by Klebsiella pneumoniae (25%) and Streptococcus sp. (7,5%). The susceptibility rate of E.coli to ceftriaxone and piperacillin/tazobactam was 65% and 88%, respectively. Carbapenem-resistant E.coli accounted for 9.9% of isolates. The susceptibility rate of K.pneumoniae to ceftriaxone and piperacillin/tazobactam was 83.9% and 93.3%, respectively. The mortality rate was 26%.

Conclusion: In decompensated cirrhosis, spontaneous bacterial peritonitis must be considered through thorough clinical evaluation, even if the patient is afebrile and lacks abdominal pain or an elevated white blood cell count. The susceptibility of E.coli to ceftriaxone has increased compared to previous study. However, carbapenem resistance was observed.

References
[1]
Devarbhavi, H., Asrani, S. K., Arab, J. P., et al. (2023). Global burden of liver disease: 2023 update. Journal of Hepatology, 79(2), 516–537. https://doi.org/10.1016/j.jhep.2023.03.017 Google Scholar
[2]
Piano, S., Singh, V., Caraceni, P., et al. (2019). Epidemiology and effects of bacterial infections in patients with cirrhosis worldwide. Gastroenterology, 156(5), 1368–1380.e10. https://doi.org/10.1053/j.gastro.2018.12.005 Google Scholar
[3]
Piano, S., Bartoletti, M., Tonon, M., et al. (2018). Assessment of Sepsis-3 criteria and quick SOFA in patients with cirrhosis and bacterial infections. Gut, 67(10), 1892–1899. https://doi.org/10.1136/gutjnl-2017-314324 Google Scholar
[4]
Singh, V., De, A., Mehtani, R., et al. (2023). Asia-Pacific association for study of liver guidelines on management of ascites in liver disease. Hepatology International, 17(4), 792–826. https://doi.org/10.1007/s12072-023-10536-7 Google Scholar
[5]
Đoàn, T. H. L. (2018). Đặc điểm điều trị kháng sinh trên bệnh nhân xơ gan viêm phúc mạc nhiễm khuẩn nguyên phát cấy dương tính tại Bệnh viện Bệnh Nhiệt Đới [Luận văn Thạc sĩ]. Đại học Y Dược Thành phố Hồ Chí Minh. Google Scholar
[6]
Trần, Đ. K., Cao, N. N., Phạm, T. L. H., et al. (2015). Hiệu quả của kháng sinh trong điều trị viêm phúc mạc nhiễm khuẩn nguyên phát trên bệnh nhân người lớn xơ gan. Tạp chí Y học Thành phố Hồ Chí Minh, 19(1), 426 Google Scholar
[7]
Biggins, S. W., Angeli, P., Garcia-Tsao, G., Ginès, P., et al. (2021). Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology (Baltimore, Md.), 74(2), 1014–1048. https://doi.org/10.1002/hep.31884 Google Scholar
[8]
European Association for the Study of the Liver (2018). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. Journal of hepatology, 69(2), 406–460. https://doi.org/10.1016/j.jhep.2018.03.024 Google Scholar
[9]
Zhang, X., Li, X. X., Song, J. W., et al. (2023). Clinical features, microbial spectrum, and antibiotic susceptibility patterns of spontaneous bacterial peritonitis in cirrhotic patients. Digestive and Liver Disease, 55(11), 1554–1561. https://doi.org/10.1016/j.dld.2023.08.045 Google Scholar
[10]
Devani, K., Charilaou, P., Jaiswal, P., et al. (2019). Trends in hospitalization, acute kidney injury, and mortality in patients with spontaneous bacterial peritonitis. Journal of Clinical Gastroenterology, 53(2), e68. https://doi.org/10.1097/MCG.0000000000000973 Google Scholar