Profile of spontaneous bacterial peritonitis and hepatitis B DNA status in chronic hepatitis B related cirrhosis.
Main Article Content
Keywords
, Chronic liver disease,Chronic Hepatitis B, Ascites and SBP
Abstract
Background: Activity of etiologic agent for chronic liver disease (CLD) has impact on treatment outcome of spontaneous bacterial peritonitis (SBP).
Aims and objectives:To studyinfection acquisition, antibiotics resistance pattern, treatment success and mortality with SBPin patients having chronic hepatitis B (CHB) related CLD in our region.These parameters were studied in context to detectable or non-detectable hepatitis B virus (HBV)deoxyribonucleic acid (DNA) status.
Materials and Methods:This observational prospective study was carried out in Government Medical College; Srinagar: over period of two years in 2017. Patients with Ascites with CHB related CLD and were taken for studied. We studied serum HBV DNA, infection acquisition, antibiotics resistance pattern, treatment success and mortality in patients of CHB related CLD with SBP.
Results:Over 2 year’s period, 246 patients were enrolled. Mean age of patients was 57.09 ± 13.90 years. Hepatitis B virus is a major etiological contributor to the burden of CLD amounting to 69 (28%) in Kashmir.SBP was present in 38 (55.06%) of chronic hepatitis B related CLD patients. Hepatitis B DNA was detectable in 71.05%. In this group 81.48% were cured.Mortality was 5 (18.51%)in patients with detectable HBV DNA and 1(9.09%)in non-detectable HBV DNA.
Conclusion:Our region CHB is the leading contributor of CLD. In this study trend towards better treatment outcome and less mortality was observed in patients with non-detectable HBV DNA in comparison to other group.
References
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14. Nobre SR, Cabral JE, Gomes JJ, Leitão MC. In-hospital mortality in spontaneous bacterial peritonitis: a new predictive model. Eur J GastroenterolHepatol. 2008; 20(12):1176-81
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23. Cho Y, Park SY, Lee JH, Lee DH, Lee M, Yoo JJ, Choi WM, Cho YY, Lee YB, Yoon JW, Kwon JH, Cho EJ, Yu SJ, Kim YJ, Yoon JH, Kim CY, Lee HS. High-sensitivity C-reactive protein level is an independent predictor of poor prognosis in cirrhotic patients with spontaneous bacterial peritonitis. J ClinGastroenterol.2014; 48: 444-449 [PMID: 24045283 DOI: 10.1097/ MCG.0b013e3182a6cdef]
24. Tandon P, Garcia-Tsao G. Renal dysfunction is the most important independent predictor of mortality in cirrhotic patients with spontaneous bacterial peritonitis. ClinGastroenterolHepatol. 2011; 9: 260-265 [PMID: 21145427 DOI: 10.1016/j cgh.2010.11.038]
25. Jindal A, Kumar M, Bhadoria AS, Maiwall R, Sarin SK. A randomized open label study of ‘imipenem vs. cefepime’ in spontaneous bacterial peritonitis. Liver Int.2016; 36: 677-687 [PMID: 26474358 DOI: 10.1111/liv.12985]
26. Tandon P, Kumar D, Seo YS, Chang HJ, Chaulk J, Carbonneau M, Qamar H, Keough A, Mansoor N, Ma M. The 22/11 risk prediction model: a validated model for predicting 30-day mortality in patients with cirrhosis and spontaneous bacterial peritonitis. Am J Gastroenterol. 2013; 108: 1473-1479 [PMID: 23877350 DOI: 10.1038/ajg.2013.204]
27. Cheong HS, Kang CI, Lee JA, Moon SY, Joung MK, Chung DR, Koh KC, Lee NY, Song JH, Peck KR. Clinical significance and outcome of nosocomial acquisition of spontaneous bacterial peritonitis in patients with liver cirrhosis. Clin Infect Dis 2009; 48: 1230-1236 [PMID: 19302016 DOI: 10.1086/597585]
28. Bunchorntavakul C, Chamroonkul N, Chavalitdhamrong D. Bacterial infections in cirrhosis: A critical review and practical guidance. World J Hepatol. 2016; 8: 307 321 [PMID: 26962397 DOI: 10.4254/wjh.v8.i6.307]
29. Shi L, Wu D, Wei L, Liu S, Zhao P, Tu B, et al. Corrigendum: nosocomial and community-acquired spontaneous bacterial peritonitis in patients with liver cirrhosis in china: comparative microbiology and therapeutic implications. Sci Rep. 2017; 7: 46868. https://bit.ly/2MIlnW9
30. Harchand P, Gupta V, Ahluwalia G, Chhina RS. Clinical and bacteriological profile of spontaneous bacterial peritonitis in cirrhotic patients. J Gastro intest Infect. 2017; 7: 15-20. Htt ps://bit.ly/341TK0e
31. Kawale JB, Kavita J. Rawat. Study of etiology, clinical profile and predictive factors of spontaneous bacterial peritonitis in cirrhosis of liver. Int J Res Med Sci. 2017; 5: 2326-2330. https://bit.ly/2BYFutb
32. K. A. Rostkowska et al, "Spontaneous bacterial peritonitis therapeutic challenges in the era of increasing drug resistance of bacteria," Clinical and Experimental Hepatology, vol. 4, no. 4. Termedia Publishing House Ltd., pp. 224–231, 2018. doi:10.5114/ceh.2018.80123.
33. S. Ho Um et al., "Clinical Features and Prognosis of Spontaneous Bacterial Peritonitis in KoreanPatients with Liver Cirrhosis: A Multicenter Retrospective Study," 2009. [Online]. Available:http://www.unos.org
34. L. Piroth et al., "Bacterial epidemiology and antimicrobial resistance in ascitic fluid: A 2-year retrospective study," Scandinavian Journal of Infectious Diseases, vol. 41, no. 11–12, pp. 847–851, 2009, doi: 10.3109/00365540903244535.
35. Wiest R et al, Spontaneous bacterial peritonitis: recent guidelines and beyond. Gut. 2012;61:297–310 8]
36. A. Ferrarese et al., "Antibiotic prophylaxis in patients with cirrhosis: Current evidence for clinical practice," World Journal of Hepatology, vol. 13, no. 8, pp. 840–852, 2021, doi:10.4254/wjh.v13.i8.840.
37. S. Marciano et al, "Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies," Hepatic Medicine: Evidence and Research, vol. Volume 11, pp. 13–22, Jan. 2019, doi: 10.2147/hmer.s164250.
38. Melcarne L et al. Prognostic factors of liver cirrhosis mortality after a first episode of spontaneous bacterial peritonitis. A multicenterstudy. Rev Esp Enferm Dig. 2018;110:94–101
39. Fiore M et al, Nosocomial spontaneous bacterial peritonitis antibiotic treatment in the era of multi-drug resistance pathogens: a systematic review. World J Gastroenterol. 2017;23:4654–4660.
40. Kamanth PS et al, The model for end-stage liver disease (MELD) Hepatology. 2007;45:797–805.
2. Conn HO, Fessel JM. Spontaneous bacterial peritonitis in cirrhosis: variations on a theme. Medicine. 1971; 50(3):161-97
3. Rimola A, Garcia Tsao G, Navasa M et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document, International Ascitis club. J Hepatol. 2000; 32: 142-153
4. Rimola A, Soto R, Bory F, Arroyo V, Piera C, Rodes J. Reticuloendothelial system phagocytic activity in cirrhosis and its relation to bacterial infections and prognosis. Hepatol. 1984; 4(1):53-8
5. Fernandez J, Navasa M, Gómez J, Colmenero J, Vila J, Arroyo V, et al. Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatol. 2000; 35(1):140-8
6. Agiasotelli D, Alexopoulou A, Vasilieva L, Hadziyannis E, Goukos D, Daikos GL, Dourakis SP. High serum lipopolysaccharide binding protein is associated with increased mortality in patients with decompensated cirrhosis. Liver Int.2017; 37: 576-582 [PMID: 27712029 DOI: 10.1111/liv.13264]
7. Bae S, Kim T, Kim MC, Chong YP, Kim SH, Sung H, Lim YS, Lee SO, Kim MN, Kim YS, Woo JH, Choi SH. Clinical characteristics and outcomes of spontaneous bacterial peritonitis caused by Enterobacter species versus Escherichia coli: a matched case control study. BMC Infect Dis. 2016; 16: 252 [PMID: 27267044 DOI: 10.1186/s12879-016-1595-y]
8. Lutz P, Goeser F, Kaczmarek DJ, Schlabe S, Nischalke HD, Nattermann J, Hoerauf A, Strassburg CP, Spengler U. Relative Ascites Polymorphonuclear Cell Count Indicates Bacterascites and Risk of Spontaneous Bacterial Peritonitis. Dig Dis Sci.2017; 62:2558-2568 [PMID: 28597106 DOI: 10.1007/s10620-017-4637-4]
9. Tsung PC, Ryu SH, Cha IH, Cho HW, Kim JN, Kim YS, Moon JS. Predictive factors that influence the survival rates in liver cirrhosis patients with spontaneous bacterial peritonitis. ClinMolHepatol. 2013; 19: 131-139 [PMID: 23837137 DOI: 10.3350/ cmh.2013.19.2.131]
10. Oladimeji AA, Temi AP, Adekunle AE, Taiwo RH, Ayokunle DS. Prevalence of spontaneous bacterial peritonitis in liver cirrhosis with ascites. Pan Afr Med J 2013; 15: 128 [PMID: 24255734 DOI: 10.11604/pamj.2013; 15.128.2702]
11. deMattos AA, Costabeber AM, Lionço LC, Tovo CV. Multiresistant bacteria in spontaneous bacterial peritonitis: a new step in management? World J Gastroenterol. 2014; 20: 14079-14086 [PMID: 25339797 DOI: 10.3748/wjg.v20.i39. 14079]
12. Schwabl P, Bucsics T, Soucek K, Mandorfer M, Bota S, Blacky A, Hirschl AM, Ferlitsch A, Trauner M, Peck-Radosavljevic M, Reiberger T. Risk factors for development of spontaneous bacterial peritonitis and subsequent mortality in cirrhotic patients with ascites. Liver Int. 2015; 35: 2121-2128 [PMID: 25644943 DOI:10.1111/liv.12795]
13. Kwon JH, Koh SJ, Kim W, Jung YJ, Kim JW, Kim BG, Lee KL, Im JP, Kim YJ, Kim JS, Yoon JH, Lee HS, Jung HC. Mortality associated with proton pump inhibitors in cirrhotic patients with spontaneous bacterial peritonitis. J GastroenterolHepatol. 2014; 29: 775-781 [PMID: 24219827 DOI: 10.1111/jgh.12426]
14. Nobre SR, Cabral JE, Gomes JJ, Leitão MC. In-hospital mortality in spontaneous bacterial peritonitis: a new predictive model. Eur J GastroenterolHepatol. 2008; 20(12):1176-81
15. Thuluvath PJ, Morss S, Thompson R. Spontaneous bacterial peritonitis - in-hospital mortality, predictors of survival, and health care costs from 1988 to 1998. Am J Gastroenterol. 2001; 96(4):1232-6
16. Hung TH, Tsai CC, Hsieh YH, Tsai CC. The long-term mortality of spontaneous bacterial peritonitis in cirrhotic patients: A 3-year nationwide cohort study. Turk J Gastroenterol. 2015; 26: 159-162 [PMID: 25835115 DOI: 10.5152/tjg.2015.4829]
17. Friedrich K, Nüssle S, Rehlen T, Stremmel W, Mischnik A, Eisenbach C. Microbiology and resistance in first episodes of spontaneous bacterial peritonitis: implications for management and prognosis. J GastroenterolHepatol.2016; 31: 1191-1195 [PMID: 26676553 DOI: 10.1111/jgh.13266]
18. Oliveira AM, Branco JC, Barosa R, Rodrigues JA, Ramos L, Martins A, Karvellas CJ, Cardoso FS. Clinical and microbiological characteristics associated with mortality in spontaneous bacterial peritonitis: a multicenter cohort study. Eur J GastroenterolHepatol. 2016; 28: 1216-1222 [PMID: 27391170 DOI: 10.1097/ MEG.0000000000000700]
19. Piano S, Fasolato S, Salinas F, Romano A, Tonon M, Morando F, Cavallin M, Gola E, Sticca A, Loregian A, Palù G, Zanus G, Senzolo M, Burra P, Cillo U, Angeli P. The empirical antibiotic treatment of nosocomial spontaneous bacterial peritonitis: Results of a randomized, controlled clinical trial. Hepatology,2016; 63: 1299-1309 [PMID: 26084406 DOI: 10.1002/hep.27941]
20. Bal CK, Daman R, Bhatia V. Predictors of fifty days in-hospital mortality in decompensated cirrhosis patients with spontaneous bacterial peritonitis. World J Hepatol.2016; 8: 566-572 [PMID: 27134704 DOI: 10.4254/wjh.v8.i12.566]
21. Poca M, Alvarado-Tapias E, Concepción M, Pérez-Cameo C,Cañete N, Gich I, Romero C, Casas M, Román E, Castells L,Vargas V, Carrión JA, Guarner C, Soriano G. Predictive model ofmortality in patients with spontaneous bacterial peritonitis. Aliment PharmacolTher.2016; 44: 629-637 [PMID: 27464682 DOI: 10.1111/apt.13745]
22. Bernardi M, Gitto S, Biselli M. The MELD score in patients awaiting liver transplant: strengths and weaknesses. J Hepatol.2011; 54: 1297-1306 [PMID: 21145851 DOI: 10.1016/j.jhep.2010.11.008]
23. Cho Y, Park SY, Lee JH, Lee DH, Lee M, Yoo JJ, Choi WM, Cho YY, Lee YB, Yoon JW, Kwon JH, Cho EJ, Yu SJ, Kim YJ, Yoon JH, Kim CY, Lee HS. High-sensitivity C-reactive protein level is an independent predictor of poor prognosis in cirrhotic patients with spontaneous bacterial peritonitis. J ClinGastroenterol.2014; 48: 444-449 [PMID: 24045283 DOI: 10.1097/ MCG.0b013e3182a6cdef]
24. Tandon P, Garcia-Tsao G. Renal dysfunction is the most important independent predictor of mortality in cirrhotic patients with spontaneous bacterial peritonitis. ClinGastroenterolHepatol. 2011; 9: 260-265 [PMID: 21145427 DOI: 10.1016/j cgh.2010.11.038]
25. Jindal A, Kumar M, Bhadoria AS, Maiwall R, Sarin SK. A randomized open label study of ‘imipenem vs. cefepime’ in spontaneous bacterial peritonitis. Liver Int.2016; 36: 677-687 [PMID: 26474358 DOI: 10.1111/liv.12985]
26. Tandon P, Kumar D, Seo YS, Chang HJ, Chaulk J, Carbonneau M, Qamar H, Keough A, Mansoor N, Ma M. The 22/11 risk prediction model: a validated model for predicting 30-day mortality in patients with cirrhosis and spontaneous bacterial peritonitis. Am J Gastroenterol. 2013; 108: 1473-1479 [PMID: 23877350 DOI: 10.1038/ajg.2013.204]
27. Cheong HS, Kang CI, Lee JA, Moon SY, Joung MK, Chung DR, Koh KC, Lee NY, Song JH, Peck KR. Clinical significance and outcome of nosocomial acquisition of spontaneous bacterial peritonitis in patients with liver cirrhosis. Clin Infect Dis 2009; 48: 1230-1236 [PMID: 19302016 DOI: 10.1086/597585]
28. Bunchorntavakul C, Chamroonkul N, Chavalitdhamrong D. Bacterial infections in cirrhosis: A critical review and practical guidance. World J Hepatol. 2016; 8: 307 321 [PMID: 26962397 DOI: 10.4254/wjh.v8.i6.307]
29. Shi L, Wu D, Wei L, Liu S, Zhao P, Tu B, et al. Corrigendum: nosocomial and community-acquired spontaneous bacterial peritonitis in patients with liver cirrhosis in china: comparative microbiology and therapeutic implications. Sci Rep. 2017; 7: 46868. https://bit.ly/2MIlnW9
30. Harchand P, Gupta V, Ahluwalia G, Chhina RS. Clinical and bacteriological profile of spontaneous bacterial peritonitis in cirrhotic patients. J Gastro intest Infect. 2017; 7: 15-20. Htt ps://bit.ly/341TK0e
31. Kawale JB, Kavita J. Rawat. Study of etiology, clinical profile and predictive factors of spontaneous bacterial peritonitis in cirrhosis of liver. Int J Res Med Sci. 2017; 5: 2326-2330. https://bit.ly/2BYFutb
32. K. A. Rostkowska et al, "Spontaneous bacterial peritonitis therapeutic challenges in the era of increasing drug resistance of bacteria," Clinical and Experimental Hepatology, vol. 4, no. 4. Termedia Publishing House Ltd., pp. 224–231, 2018. doi:10.5114/ceh.2018.80123.
33. S. Ho Um et al., "Clinical Features and Prognosis of Spontaneous Bacterial Peritonitis in KoreanPatients with Liver Cirrhosis: A Multicenter Retrospective Study," 2009. [Online]. Available:http://www.unos.org
34. L. Piroth et al., "Bacterial epidemiology and antimicrobial resistance in ascitic fluid: A 2-year retrospective study," Scandinavian Journal of Infectious Diseases, vol. 41, no. 11–12, pp. 847–851, 2009, doi: 10.3109/00365540903244535.
35. Wiest R et al, Spontaneous bacterial peritonitis: recent guidelines and beyond. Gut. 2012;61:297–310 8]
36. A. Ferrarese et al., "Antibiotic prophylaxis in patients with cirrhosis: Current evidence for clinical practice," World Journal of Hepatology, vol. 13, no. 8, pp. 840–852, 2021, doi:10.4254/wjh.v13.i8.840.
37. S. Marciano et al, "Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies," Hepatic Medicine: Evidence and Research, vol. Volume 11, pp. 13–22, Jan. 2019, doi: 10.2147/hmer.s164250.
38. Melcarne L et al. Prognostic factors of liver cirrhosis mortality after a first episode of spontaneous bacterial peritonitis. A multicenterstudy. Rev Esp Enferm Dig. 2018;110:94–101
39. Fiore M et al, Nosocomial spontaneous bacterial peritonitis antibiotic treatment in the era of multi-drug resistance pathogens: a systematic review. World J Gastroenterol. 2017;23:4654–4660.
40. Kamanth PS et al, The model for end-stage liver disease (MELD) Hepatology. 2007;45:797–805.
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Nov 04, 2025
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Wani Zeeshan Ahmad, Beigh Mashkoor Ahmad, Mir Mohamad Muzzafer, Akhter Zahid, Bhat Umer Amin, & Khuroo Waseem Imtiyaz. (2025). Profile of spontaneous bacterial peritonitis and hepatitis B DNA status in chronic hepatitis B related cirrhosis. Journal of Population Therapeutics and Clinical Pharmacology, 32(9), 1360-1367. https://doi.org/10.53555/x610ep69
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Author Biographies
Wani Zeeshan Ahmad
Associate Professor, Department of Gastroenterology, Super speciality Hospital, Government Medical College; Srinagar; Jammu Kashmir: India.
Beigh Mashkoor Ahmad
Associate Professor, Head: Department of Medicine, Government Medical College, Anantnag; Jammu Kashmir: India
Mir Mohamad Muzzafer
Consultant Medicine, Department of Medicine, Government Medical College, Anantnag; Jammu Kashmir: India.
Akhter Zahid
Diplomate of national board Scholar, Department of Medicine, Government Medical College, Anantnag; Jammu Kashmir: India.
Bhat Umer Amin
Intern, Government Medical College, Anantnag; Jammu Kashmir: India.
Khuroo Waseem Imtiyaz
Intern, Government Medical College, Anantnag; Jammu Kashmir: India.
How to Cite
Wani Zeeshan Ahmad, Beigh Mashkoor Ahmad, Mir Mohamad Muzzafer, Akhter Zahid, Bhat Umer Amin, & Khuroo Waseem Imtiyaz. (2025). Profile of spontaneous bacterial peritonitis and hepatitis B DNA status in chronic hepatitis B related cirrhosis. Journal of Population Therapeutics and Clinical Pharmacology, 32(9), 1360-1367. https://doi.org/10.53555/x610ep69