End Stage Liver Disease, Infection, Spontaneous Bacterial Peritonitis
Conditions
Brief summary
Spontaneous bacterial peritonitis (SBP) is a common complication of end-stage liver disease due to various causes. The initial anti-infective medication is appropriate and the patient's survival rate is closely related. Ascitic fluid bacterial culture takes a long time, the positive rate is low, it is difficult to guide the timely use of antimicrobial drugs, empirical medicine based on evidence-based medicine for SBP in patients with end-stage liver disease is essential. The American College of Hepatology and the European Society of Hepatology recommend the use of third-generation cephalosporins as the first choice of empirical therapy in patients with end-stage liver disease associated with community-acquired SBP. Patients with merger of hospital-acquired SBP with piperacillin / tazobactam or carbapenem +/- glycopeptide antibiotics is the first choice for empirical medication. There is no clear recommendation in China. In recent years, the conclusions of international clinical research in this area have been in disagreement with the recommendations. As a key factor in the selection of empirical antibiotics is local bacterial resistance data, these findings are difficult to evidence-based medicine for Chinese doctors. This project intends to observe the efficacy of different initial anti-infective regimens in Chinese patients with end-stage liver disease with SBP and 30-day and 60-day non-liver transplant survival rates, providing evidence-based medical evidence for the empirical use of such patients.
Interventions
DRUGAntibiotics
This is an observation study, no specific antibiotics will be indicated during treatment.
Sponsors
Tongji Hospital
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
1. Meet the end-stage liver disease part of the type of standard (including slow plus acute liver failure, chronic liver failure, cirrhosis decompensation); 2. age\> 18 years old 3. ascites nucleated cell count\> 250 × 106 / L; 4. Unable to obtain ascites specimens or ascites nucleated cells count does not meet the conditions of 3) are required abdominal examination tenderness (+), rebound tenderness (+), abdominal ultrasound can detect ascites, and procalcitonin (PCT) \> 0.5ng / ml, hs-CRP\> 10ng / ml
Exclusion criteria
1. history of abdominal surgery within 4 weeks; 2. secondary peritonitis; 3. tuberculous peritonitis; 4. Malignant tumor; 5. patients who use hormones or immunosuppressants; 6. AIDS patients; 7. heart failure or respiratory failure; 8. merge other parts of the infection; 9. died within 48h; 10. liver transplantation during observation; 11. Diagnosis of spontaneous bacterial peritonitis is the use of carbapenems or third-generation cephalosporins / enzyme inhibitors, piperacillin / enzyme inhibitor antibiotics
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Complete response rate to empirical antibiotic treatment | 6 months | The percentage of patients who achieved complete recovery from combined infection after empirical antibiotic treatment |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Non-liver transplant survival | 6 months | Non-liver transplant survival rate at 30 days, 60 days and 6 months after empirical antibiotic treatment |
| Hospitalization time | 6 months | Days of hospitalization after empirical antibiotic treatment |
Countries
China
Outcome results
None listed