Spontaneous bacterial peritonitis in cirrhosis: Predictive factors of infection resolution and survival in patients treated with cefotaxime

Abstract

Cefotaxime is the most commonly used antibiotic for initial therapy of spontaneous bacterial peritonitis in cirrhosis. However, since the introduction of cefotaxime no study has been performed to investigate factors influencing prognosis in cirrhotic patients with this type of infection. In this study, predictive factors for infection resolution and patient survival were investigated in 213 consecutive episodes of spontaneous bacterial peritonitis in 185 cirrhotic patients. All patients were initially treated with cefotaxime. One hundred sixty-five episodes (77%) resolved with cefotaxime alone, and two more episodes (1%), initially unresponsive to cefotaxime, were cured after modification of antibiotic therapy. In a multivariate analysis (stepwise logistic regression), only 4 of 51 clinical and laboratory variables obtained at the time of diagnosis of infection were identified as independent predictors of infection resolution: band neutrophils in white blood cell count, community-acquired vs. hospitalacquired peritonitis, blood urea nitrogen level and serum aspartate aminotransferase level. No patient experienced serious adverse effects related to cefotaxime. Eighty-two patients died during hospitalization (38% mortality rate in relation to the 213 episodes of peritonitis). In the multivariate analysis, six variables were independently correlated with survival: blood urea nitrogen level, serum aspartate aminotransferase level, community-acquired vs. hospitalacquired peritonitis, age, Child-Pugh score and ileus. No microbiological data had predictive value for infection resolution or survival. These results indicate that in cirrhotic patients with spontaneous bacterial peritonitis treated with cefotaxime, infection resolution and patient survival may be predicted by several clinical and laboratory variables obtained at the time of infection diagnosis; the most important are blood urea nitrogen level, serum aspartate aminotransferase level and site (community or hospital) of peritonitis acquisition. (Hepatology 1993;17:251-257.)