The Cilinical Comparison Between Two Kinds Of Noncommunity-acquired Spontaneous Bacterial Peritonitis And The Predictive Factor For Short-term Survival

Objective This research was designed to compare the clinical features and pathogen profle between NA-SBP and HCA-SBP,and to find out the factor that could predict the short-term survival of noncommunity-acquired spontaneous peritonitis.Methods We analyzed the data of 42 patients with liver cirrhosis and first episode of spontaneous bacterial peritonitis at the First Affliated Hospital of Zhejiang University between January 2014 and June 2016.Only ascites culture positive patients were included and community-acquired spontaneous bacterial peritonitis were excluded.Results NA-SBP and HCA-SBP occured in 19 and 23 patients,respectively.The leukocyte counts were much higher in NA-SBP than HCA-SBP(10.6�1.9 VS 6.0�10.7,p<0.001).So were the ascites polymorphonuclear leukocytes(PMN)(2938.6�1000.9 VS 664.9�359.0,p=0.013).No differences were shown in rest baseline characters,complications or 28-day mortality.Gram-positive bacterias accounted for 63.2%of 19 NA-SBP isolates,Gram-negative bacterias accounted for 52.2%of 23 HCA-SBP isolates.The resistence to third-generation cephalosporins(36.8%VS 21.7%,p=0.281)and quinolones(42.1%VS 26.1%,p=0.273)were significant in both NA-SBP and HCA-SBP.The isolates of enterococcus were high in both groups(21.%VS 17.4%,p=1.000).Of all 42 patients,only one was resistant to carbapenems.In the single factor survival analysis,white blood cells>10*10^9/L,MELD score>20 points,MELD-Na score>25 points,combined with liver cancer,complicated with acute renal injury and hepatic encephalopathy(grade3-4)were clearly related with 28 Days mortality of noncommunity-acquired SBP.In multivariate analysis,acute renal injury was significantly associated with 28-day mortality of noncommunity-acquired SBPConclusions The acquisition site of infection(NA-SBP VS HCA-SBP)did not affect clinical outcomes and the baselines were similar between these two groups.The resistance to third-generation cephalosporins and quinolones were both high but most isolates were sensitive to carbapenems.Third-generation cephalosporins may be unsufficient in empirically treating these patients.Acute renal injury during hospitalization is an independent risk factor for predicting 28-days mortality of noncommunity-acquired SBP.