• ascites
• fungiascites
• nomogram
• spontaneous bacterial peritonitis
• spontaneous fungal peritonitis

• 2022-1-2181 Capital Medical Development and Research Fund
• BJYAYY-YN2022-07 Young and Middle-aged Talent Incubation Programme of Beijing You'an Hospital

• acute-on-chronic liver failure (ACLF)
• cirrhosis-associated immune dysfunction (CAID)
• compensated and decompensated cirrhosis
• immune paralysis
• inflammation

• ACLF
• antifungals
• cirrhosis
• invasive fungal infections
• machine learning
• mortality

• candidemia
• end-stage liver disease
• invasive fungal infection
• invasive pulmonary aspergillosis
• liver impairment
• severe alcoholic steatohepatitis

• Candida
• Cirrhosis
• Invasive candidiasis
• fungal infection
• meta-analysis
• mortality
• systematic review

• Acute-On-Chronic Liver Failure/microbiology
• Acute-On-Chronic Liver Failure/mortality
• Candidiasis, Invasive/pathology
• End Stage Liver Disease/microbiology
• End Stage Liver Disease/mortality
• Humans
• Intensive Care Units
• Liver Cirrhosis/microbiology
• Liver Cirrhosis/mortality
• Severity of Illness Index

• Cirrhosis
• Cryptococcus
• cryptococcal antigen
• peritonitis

• ascites
• candida glabrata
• peritonitis

• Antifungal Agents/therapeutic use
• Ascites/complications
• Candida glabrata/drug effects
• Caspofungin/therapeutic use
• Diagnosis, Differential
• Female
• Fibrosis/complications
• Humans
• Middle Aged
• Mycoses/diagnosis
• Mycoses/drug therapy
• Mycoses/etiology
• Myocardium/pathology
• Peritonitis/diagnosis
• Peritonitis/drug therapy
• Peritonitis/etiology
• Time Factors

Spontaneous peritonitis is one of the most common infectious complications in cirrhotic patients with ascites. Spontaneous fungal peritonitis (SFP) is a type of spontaneous peritonitis that is a less recognized but devastating complication in end-stage cirrhosis. Although high mortality was previously noted, scant data are available to fully define the factors responsible for the occurrence of SFP and its mortality.

To illustrate the differences between SFP and spontaneous bacterial peritonitis (SBP) and discuss the risk factors for the occurrence of SFP and its short-term mortality.

We performed a matched case-control study between January 1, 2007 and December 30, 2018. Patients with SFP were included in a case group. Sex-, age-, and time-matched patients with SBP were included in a control group and were further divided into control-1 group (positive bacterial culture) and control-2 group (negative bacterial culture). The clinical features and laboratory parameters, severity models, and prognosis were compared between the case and control groups. Logistic regression analysis was used to determine the risk factors for occurrence, and the Cox regression model was used to identify the predictive factors for short-term mortality of SFP.

Patients with SFP exhibited more severe systemic inflammation, higher ascites albumin and polymorphonuclear neutrophils, and a worsened 15-d mortality than patients in the control groups. Antibiotic administration (case vs control-1: OR = 1.063, 95%CI: 1.012-1.115, P = 0.014; case vs control-2: OR = 1.054, 95%CI: 1.014-1.095, P = 0.008) remarkably increased the occurrence of SFP or fungiascites. Hepatorenal syndrome (HR = 5.328, 95%CI: 1.050-18.900) and total bilirubin (μmol/L; HR = 1.005, 95%CI: 1.002-1.008) represented independent predictors of SFP-related early mortality.

Long-term antibiotic administration increases the incidence of SFP, and hepatorenal syndrome and total bilirubin are closely related to short-term mortality.

• Spontaneous fungal peritonitis
• Risk factor
• Cirrhosis

Spontaneous peritonitis is an infection of ascitic fluid without a known intra-abdominal source of infection. spontaneous fungal peritonitis (SFP) is a potentially fatal complication of decompensated cirrhosis, defined as fungal infection of ascitic fluid in the presence of ascitic neutrophil count of greater than 250 cells/mL.

To determine the prevalence of fungal pathogens, management and outcomes (mortality) of SFP in critically ill cirrhotic patients.

Studies were identified using PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Scopus databases until February 2019. Inclusion criteria included intervention trials and observation studies describing the association between SFP and cirrhosis. The primary outcome was in-hospital, 1-mo, and 6-mo mortality rates of SFP in cirrhotic patients. Secondary outcomes were fungal microorganisms identified and in hospital management by anti-fungal medications. The National Heart, Lung and Blood Institute quality assessment tools were used to assess internal validity and risk of bias for each included study.

Six observational studies were included in this systematic review. The overall quality of included studies was good. A meta-analysis of results could not be performed because of differences in reporting of outcomes and heterogeneity of the included studies. There were 82 patients with SFP described across all the included studies. Candida species, predominantly Candida albicans was the fungal pathogen in majority of the cases (48%-81.8%) followed by Candida krusei (15%-25%) and Candida glabrata (6.66%-20%). Cryptococcus neoformans (53.3%) was the other major fungal pathogen. Antifungal therapy in SFP patients was utilized in 33.3% to 81.8% cases. The prevalence of in hospital mortality ranged from 33.3% to 100%, whereas 1-mo mortality ranged between 50% to 73.3%.

This systematic review suggests that SFP in end stage liver disease patient is associated with high mortality both in the hospital and at 1-mo, and that antifungal therapy is currently underutilized.

• Spontaneous fungal peritonitis
• Bacterial peritonitis
• Liver
• Cirrhosis
• Critical

• Advanced liver diseases
• cirrhosis
• multidrug-resistant
• nosocomial
• spontaneous bacterial peritonitis
• spontaneous fungal peritonitis.

• Bacterial Infections/complications
• Bacterial Infections/diagnosis
• Bacterial Infections/therapy
• Community-Acquired Infections/microbiology
• Community-Acquired Infections/therapy
• Cross Infection/microbiology
• Cross Infection/therapy
• Humans
• Liver Cirrhosis/etiology
• Liver Cirrhosis/therapy
• Mycoses/complications
• Mycoses/diagnosis
• Mycoses/therapy
• Peritonitis/complications
• Peritonitis/microbiology
• Peritonitis/therapy

• Antimicrobial resistance
• Chronic liver disease
• Epidemiology

• ACLF
• ALF
• CLF
• Efficiency
• Equity
• Futile
• Liver transplant
• Organ shortage

Spontaneous bacterial (SBP) and spontaneous fungal peritonitis (SFP) can be a life-threatening infection in patients with liver cirrhosis (LC) and ascites. One of the possible mechanisms of developing SBP is bacterial translocation. Although the number of polymorphonuclear cells in the culture of ascitic fluid is diagnostic for SBP, secondary bacterial peritonitis is necessary to exclude. The severity of underlying liver dysfunction is predictive of developing SBP; moreover, renal impairment and infections caused by multidrug-resistant (MDR) organism are associated with a fatal prognosis of SBP. SBP is treated by antimicrobials, but initial empirical treatment may not succeed because of the presence of MDR organisms, particularly in nosocomial infections. Antibiotic prophylaxis is recommended for patients with LC at a high risk of developing SBP, gastrointestinal bleeding, or a previous episode of SBP, but the increase in the risk of developing an infection caused by MDR organisms is a serious concern globally. Less is known about SFP in patients with LC, but the severity of underlying liver dysfunction may increase the hospital mortality. SFP mortality has been reported to be higher than that of SBP partially because the difficulty of early differentiation between SFP and SBP induces delayed antifungal therapy for SFP.

• Liver cirrhosis
• Spontaneous bacterial peritonitis
• Spontaneous fungal peritonitis
• Bacterial infections

Spontaneous fungal peritonitis (SFP) is an infrequent but severe complication most commonly described in patients with liver cirrhosis. We present the first case of culture-proven SFP occurring in cardiogenic ascites. The diagnosis of SFP was clinically challenging as the initial ascites was consistent with the more common diagnosis of spontaneous bacterial peritonitis (SBP). The patient did not respond to antibacterial therapy, however, and the final diagnosis was only made with positive ascitic cultures that grew Candida glabrata. SFP should be considered in patients with either cardiac or cirrhotic ascites and have a delayed or lack of response to traditional SBP treatment.

• Antifungal therapy
• Candidemia
• Diagnosis
• Guidelines
• Invasive candidiasis
• Resistance

• Antifungal Agents/therapeutic use
• Candida/classification
• Candidemia/diagnosis
• Candidemia/drug therapy
• Candidiasis, Invasive/diagnosis
• Candidiasis, Invasive/drug therapy
• Drug Resistance, Fungal
• Early Diagnosis
• Echinocandins/therapeutic use
• Humans
• Microbial Sensitivity Tests
• Randomized Controlled Trials as Topic

• Cirrhosis
• Critically ill patient
• Fungal ascitis
• Life-threatening infections
• Nosocomial spontaneous peritonitis
• Spontaneous fungal peritonitis

• Antifungal Agents/therapeutic use
• Ascites/microbiology
• Ascitic Fluid/microbiology
• Bacterial Infections/complications
• Bacterial Infections/epidemiology
• Bacterial Infections/microbiology
• Bacterial Infections/therapy
• Critical Illness
• Cross Infection/complications
• End Stage Liver Disease/complications
• Humans
• Liver Cirrhosis/complications
• Mycoses/complications
• Mycoses/epidemiology
• Mycoses/microbiology
• Mycoses/therapy
• Peritonitis/complications
• Peritonitis/epidemiology
• Peritonitis/microbiology
• Peritonitis/therapy
• Risk Factors

• Antifungal Agents
• Humans
• Mycoses
• Peritonitis