Background: Spontaneous ascites fluid infection (SAFI) is an extremely serious and frequently encountered complication in cirrhotic patients. We aimed to determine the prevalence of SAFI and the factors associated with it in the largest hospital in Cotonou. Methods: This was a retrospective descriptive and analytical study conducted from January 2013 to July 2019, at the National and University Hospital Hubert Koutoukou Maga (CNHU-HKM) in Cotonou, Benin. All patients followed in the University Clinic of Hepato-Gastroenterology and diagnosed with SAFI were included. Results: Eighty-two patients were included, predominantly males (69.5%), with a mean age of 51.5 ± 14.5 years. Among them, 32 had SAFI, i.e., a prevalence of 39%. Of the 32 cases of SAFI, the culture of ascites fluid was positive in 6 cases (18.7%). The most frequent germ found in SAFI was Escherichia coli (5 patients, 83.3%). The factors associated with SAFI in this study were: abdominal pain (p = 0.004), increased bilirubinemia (p = 0.009), decreased prothrombin level <50% (p = 0.007), cloudy macroscopic appearance of the fluid (p < 0.001), ascites protide level <15 g/L (p = 0.001), and severe cirrhosis, with a high Child Pugh C score or MELD score >20 (p = 0.001). Conclusion: SAFI was common in cirrhotic patients in the department. Certain clinical and paraclinical factors were associated with it, as was the severity of cirrhosis. Early diagnosis and aetiological management of cirrhosis could reduce its frequency.
References
[1]
Grange, J.D. (2006) Infection au cours de la cirrhose. Gastroentérologie Clinique et Biologique, 30, 891-898. https://doi.org/10.1016/S0399-8320(06)73338-3
[2]
Ning, N., Li, T., Zhang, J., et al. (2018) Clinical and Bacteriological Features and Prognosis of Ascitic Fluid Infection in Chinese Patients with Cirrhosis. BMC Infectious Diseases, 18, Article No. 253. https://doi.org/10.1186/s12879-018-3101-1
[3]
Kom Mogto, A.D. (1999) Infections spontanées du liquide d’ascite: Aspects cliniques, biologiques et évolutifs. Master’s Thesis, Université d’Abomey-Calavi, Abomey-Calavi.
[4]
Rimola, A. and Navasa, M. (2002) Infections et maladies hépatiques. In: Benhamou, J.P., Bircher, J., Mclntyre, N., et al., Eds., Hépatologie clinique, 2ème Edition, Flammarion Médecine-Sciences, Paris, 1861-1874.
[5]
Moriceau-Beauchant, M., Ducroix, J.P., Metrau, J.M., et al. (1992) Traitement de la péritonite bactérienne spontanée du cirrhotique par l’Ofloxacine (Oflocet) par voie orale en monothérapie. Médecine et chirurgie digestives, 21, 422-426.
[6]
Marciano, S., Diaz, J.M., Dirchwolf, M. and Gadano, A. (2019) Spontaneous Bacterial Peritonitis in Patients with Cirrhosis: Incidence, Outcomes and Treatment Strategies. Hepatic Medicine Evidence and Research, 11, 13-22. https://doi.org/10.2147/HMER.S164250
European Association for the Study of the Liver (2010) EASL Clinical Practice Guidelines on the Management of Ascites, Spontaneous Bacterial Peritonitis, and Hepatorenal Syndrome in Cirrhosis. Journal of Hepatology, 53, 397-417. https://doi.org/10.1016/j.jhep.2010.05.004
[9]
Navasa, M., Rimola, A. and Rodés, J. (1997) Bacterial Infections in Liver Disease. Seminars in Liver Disease, 17, 323-333. https://doi.org/10.1055/s-2007-1007209
[10]
Diarra, A.B. (2008) Infection du liquide d’ascite chez le cirrhotique dans le service d’Hépato gastroentérologie du CHU Gabriel Touré. Master’s Thesis, Université de Bamako, Mali.
[11]
Rimola, A., Soto, R., Bory, F., et al. (1984) Reticuloendothelial System Phagocytic Activity in Cirrhoris and Its Relation to Bacterial Infections and Prognosis. Hepatology, 4, 53-58. https://doi.org/10.1002/hep.1840040109
[12]
Laah Njoho, S. (1998) Les infections spontanées du liquide d’ascite chez le cirrhotique: étude clinique et biologique. Master’s Thesis, Université de Yaoundé, Yaoundé.
[13]
Garcia-Tsao, G. (2001) Current Management of the Complications of Cirrhosis and Portal Hypertension: Variceal Hemorrhage, Ascites, and Spontaneous Bacterial Peritonitis. Gastroenterology, 120, 726-748. https://doi.org/10.1053/gast.2001.22580
[14]
Almdal, T.P. and Skinhoj, P. (1987) Spontaneous Bacterial Peritonitis in Cirrhosis: Incidence, Diagnosis, and Prognosis. Scandinavian Journal of Gastroenterology, 22, 295-300. https://doi.org/10.3109/00365528709078594
[15]
Shizuma, T. (2018) Spontaneous Bacterial and Fungal Peritonitis in Patients with Liver Cirrhosis: A Literature Review. World Journal of Hepatology, 10, 254-266. https://doi.org/10.4254/wjh.v10.i2.254
[16]
Bouzaidi, S., Salem, M., Ben-Yedder, J., et al. (2003) L’infection spontanée du liquide d’ascite chez le cirrhotique: A propos de 64 cas. Maghreb Médical, 366, 87-90.
[17]
Maiga, M.Y., Traore, H.A., Maiga, I.I., et al. (1996) L’infection du liquide d’ascite dans les services de médecine à l’Hôpital National du Point 《G》. Médecine et chirurgie digestives, 25, 219-222.
[18]
Attia, K.A., N’dri-Yoman, T., Sawadogo, A., et al. (2001) L’infection spontanée du liquide chez le cirrhotique africain. L’étude descriptive à propos de 12 cas. Bulletin de la Société de pathologie exotique, 94, 319-321.
[19]
Amoako, D. and Kofi, N.N. (2019) Prevalence and Predictors for Spontaneous Bacterial Peritonitis in Cirrhotic Patients with Ascites Admitted at Medical Block in Korle-Bu Teaching Hospital, Ghana. Pan African Medical Journal, 33, Article 35. https://doi.org/10.11604/pamj.2019.33.35.18029
[20]
Cristina, L.G., Renata, V.S., Paulo, C. and Presa, J. (2019) Bacterial Infections in Patients with Liver Cirrhosis in an Internal Medicine Department. GE—Portuguese Journal of Gastroenterology, 26, 324-332. https://doi.org/10.1159/000494568
[21]
Runyon, B.A. (1993) Ascite and Spontaneous Bacterial Peritonitis. In: Feldman, M., Scharschmidt, B.F., Sleisenger, M.H., Eds., Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management (5th Edition), WB Saunders, Philadelphia, 1977-2003.
[22]
Tito, L., Rimola, A., Gines, P., et al. (1988) Recurrence of Spontaneous Bacterial Peritonitis in Cirrhosis: Frequency and Predictive Factors. Hepatology, 8, 27-31. https://doi.org/10.1002/hep.1840080107
[23]
Chagneau, C. (2004) Traitement et prévention de l’infection du liquide d’ascite. Gastroentérologie Clinique et Biologique, 28, B138-B145. https://doi.org/10.1016/S0399-8320(04)95249-9
[24]
Ricart, E., Soriano, G., Novella, M.T., et al. (2000) Amoxicillin-Clavulanic Acid versus Cefotaxime in the Therapy of Bacterial Infections in Cirrhotic Patients. Journal of Hepatology, 32, 596-602. https://doi.org/10.1016/S0168-8278(00)80221-4
[25]
Piroth, L., Pechinot, A., Di Martino, V., et al. (2014) Evolving Epidemiology and Antimicrobial Resistance in Spontaneous Bacterial Peritonitis: A Two-Year Observational Study. BMC Infectious Diseases, 14, Article No. 287. https://doi.org/10.1186/1471-2334-14-287
