Effects of Different Antibiotics in the Treatment of Cirrhotic Patients with Culture-Negative Neutrocytic Ascites or Spontaneous Bacterial Peritonitis

抗生素對肝硬化合併嗜中性白血球過多症腹水感染或自發性細茵性腹水感染的治療效果之探討

洪志聖(Chih-Sheng Hung) ； 李嘉龍(Chia-Long Lee) ； 陳振寬(Tzen-Kwan Chen) ； 吳啓華(Chi-Hwa Wu) ； 楊賢馨(Sien-Sing Yang) ； 賴永智(Yung-Chih Lai)

《臺灣消化醫學雜誌》 21卷4期 (2004/12) Pp. 240-248

https://doi.org/10.6557/GJT.200412_21(4).0001

摘要

Ascitic infection is a major cause of morbidity and mortality in liver cirrhosis patients. Many reports suggest that at least 5 days of third generation cephalosporin is better than a conventional first generation cephalosporin or amoxicillin plus an aminoglycoside for treating ascitic infections.
We retrospectively reviewed 54 patients with culture-negative neutrocytic ascites (CNNA) or spontaneous bacterial peritonitis (SBP) who were treated with an intravenous first generation cephalosporin plus short-term gentamicin, or a second or third generation cephalosporin. Thirteen patients with CNNA (group A) were treated with an intravenous first generation cephalosporin plus short-term gentamicin intravenous drip (regimen Ⅰ). Another 18 CNNA patients (group B) were treated with an intravenous second or third generation cephalosporin monotherapy (regimen Ⅱ). Seven patients with SBP (group C) were treated with regimen Ⅰ and 16 patients with SBP (group D) were treated with regimen Ⅱ. Three and 16 patients with shock on admission were treated with regimen Ⅰ or Ⅱ respectively. We compared the success rates of these two regimens in CNNA and SBP groups.
The successful treatment rates were 92.3% (12/13), 67.7% (12/18), 57.1% (4/7) and 37.5% (6/16) for groups A, B, C, D, respectively. The difference in success rates between regimen Ⅰ and regimen Ⅱ in the CNNA group or SBP group was not statistically significantly. However, the success rates for antibiotics given to non-septic shock patients and septic shock patients were significantly different (non-septic shock: 32/35 vs. septic shock: 2/19, p＜0.05,)
A first generation cephalosporin plus short-term gentamicin has good effect to treat CNNA patients not in shock. But it should be used cautiously to prevent acute renal failure in cirrhosis patients. Broader spectrum antibiotics should be used in patients with shock or any clinical deterioration.

關鍵字

嗜中性白血球過多腹水感染 ； 自發性細菌性腹膜炎 ； 敗血性休克 ； 肝硬化

並列摘要

Ascitic infection is a major cause of morbidity and mortality in liver cirrhosis patients. Many reports suggest that at least 5 days of third generation cephalosporin is better than a conventional first generation cephalosporin or amoxicillin plus an aminoglycoside for treating ascitic infections.
We retrospectively reviewed 54 patients with culture-negative neutrocytic ascites (CNNA) or spontaneous bacterial peritonitis (SBP) who were treated with an intravenous first generation cephalosporin plus short-term gentamicin, or a second or third generation cephalosporin. Thirteen patients with CNNA (group A) were treated with an intravenous first generation cephalosporin plus short-term gentamicin intravenous drip (regimen Ⅰ). Another 18 CNNA patients (group B) were treated with an intravenous second or third generation cephalosporin monotherapy (regimen Ⅱ). Seven patients with SBP (group C) were treated with regimen Ⅰ and 16 patients with SBP (group D) were treated with regimen Ⅱ. Three and 16 patients with shock on admission were treated with regimen Ⅰ or Ⅱ respectively. We compared the success rates of these two regimens in CNNA and SBP groups.
The successful treatment rates were 92.3% (12/13), 67.7% (12/18), 57.1% (4/7) and 37.5% (6/16) for groups A, B, C, D, respectively. The difference in success rates between regimen Ⅰ and regimen Ⅱ in the CNNA group or SBP group was not statistically significantly. However, the success rates for antibiotics given to non-septic shock patients and septic shock patients were significantly different (non-septic shock: 32/35 vs. septic shock: 2/19, p＜0.05,)
A first generation cephalosporin plus short-term gentamicin has good effect to treat CNNA patients not in shock. But it should be used cautiously to prevent acute renal failure in cirrhosis patients. Broader spectrum antibiotics should be used in patients with shock or any clinical deterioration.

並列關鍵字

culture-negative neutrocytic ascites ； spontaneous bacterial peritonitis ； septic shock ； cirrhosis