| Objectives:To investigate the effect of different antibiotic strategies on the prognosis of acute on chronic severe hepatitis B compared with spontaneous bacterial peritonitis.Methods:1.Research objectFrom January 2013 to December 2016,306 patients were definitely diagnosed to be acute on chronic severe hepatitis B complicated with SBP in our hospital.All cases of acute on chronic severe hepatitis B clinical diagnosis were in line with the guidelines for the diagnosis and treatment of liver failure（2012 Edition）[1],The diagnostic criteria for spontaneous bacterial peritonitis were in line with the European Association for the Study of the Liver（2010）guidelines for EASL clinical practice guidelines on the management of ascites,spontaneous bacterial peritonitis,and hepatorenal syndrome in cirrhosis（for short the European Society of Hepatology guidelines in 2010）.Criteria for exclusion included:（1）minors;（2）combined with the liver or other system malignant tumor;（3）mpregnant or lactating women;（4）Other immune system diseases or long-term use of immunosuppressive agents;（5）All patients had hepatic encephalopathy,upper gastrointestinal hemorrhage,hepatorenal syndrome,refractory ascites,secondary fungal infection and other complications before the diagnosis of SBP.2.Research methodAll cases diagnosed as severe hepatitis with SBP,according to the strategy of antibiotic use,which can be divided into escalation and de-escalation groups.Age,sex,liver and renal function,coagulation function,routine biochemical and microbiological culture of ascites were collected,and there was no difference in baseline data between the two groups.Two groups of patients were given liver protection,yellow,supplement energy,anti-virus,blood product support treatment or artificial liver treatment and other comprehensive treatment;The incidence of complications such as hepatic encephalopathy,upper gastrointestinal bleeding,hepatorenal syndrome,refractory ascites,secondary fungal infection,and the final outcome（survival/death）of the two groups were analyzed.Results:1.In the 306 cases of general data,antibiotics de-escalation group in 151 cases,antibiotic escalation group in 155 cases,whose gender,age,serum albumin,serum albumin,total bilirubin,international normalized ratio（INR）,prothrombin time（PT）,ascites cell count and other clinical data were compared between the two groups,and the difference was not statistically significant（P>0.05）.2.The two groups of patients were diagnosed as SBP,control of abdominal infection within 1 weeks,statistical displayed,that the effect of 128/151（1 weeks）on the control of SBP was significantly better than that of ascending step group（82/155）,P<0.01,and the difference between the two groups was significant.3.Efficacy and prognosisIn 151 cases of antibiotic de-escalation group,the incidence of patients with hepatic encephalopathy,upper gastrointestinal bleeding,refractory ascites,hepatorenal syndrome was lower than that of escalation group,and the incidence of hepatic encephalopathy and intractable ascites was statistically significant（P<0.05）.Two groups of patients in antiinfection treatment,and there was no significant difference in the incidence of fungal infection.There was significant difference between the two groups（P<0.05）,for the mortality rate of de-escalation group was 26.49%（40/151）,and the mortality rate of escalation group was43.87%（68/155）.4.Two groups of patients with ascites general bacterial culture results:Detailed collecting the ascites bacterial culture results of 306 patients,among them,the positive rate of escalation group was 25.3%（39/155）;The positive rate of de-escalation group was 24.1%（36/151）;Among them,ESBLS producing Escherichia coli accounted for 48.5%（36/75）,ESBLs（-）accounted for 51.5%（39/75）.Gram negative bacilli accounted for 71.7%（54/75）,the Escherichia coli accounted for36.2%（27/75）,Klebsiella pneumoniae accounted for 17.3%（13/75）,Acinetobacter Bauman accounted for 12%（9/75）,Pseudomonas aeruginosa accounted for 4.5%（3/75）;Gram positive cocci accounted for 28.2%（21/75）,The Staphylococcus aureus accounted for 7.6%（6/75）,Enterococcus faecium accounted for 2.7%（2/75）,other bacteria such as Enterococcus faecalis,and so on.Conclusion:Acute on chronic severe hepatitis B complicated with spontaneous bacterial peritonitis has a poor prognosis,and this study suggests that antibiotic therapy can effectively control SBP,which can reduce the incidence of complications such as hepatic encephalopathy and intractable ascites,reducing the mortality of severe hepatitis,improving the outcomes of patients as much as possible. |
PDF Full Text Request