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World J Hepatol. Feb 27, 2018; 10(2): 254-266
Published online Feb 27, 2018. doi: 10.4254/wjh.v10.i2.254
Spontaneous bacterial and fungal peritonitis in patients with liver cirrhosis: A literature review
Toru Shizuma
Toru Shizuma, Department of Physiology, Tokai University School of Medicine, Isehara 2591193, Japan
Author contributions: Shizuma T prepared the manuscript.
Conflict-of-interest statement: There is no conflict of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Toru Shizuma, MD, PhD, Associate Professor, Department of Physiology, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa 2591193, Japan. shizuma@is.icc.u-tokai.ac.jp
Telephone: +81-463-931121 Fax: +81-463-936684
Received: November 28, 2017
Peer-review started: November 28, 2017
First decision: December 18, 2017
Revised: December 31, 2017
Accepted: January 23, 2018
Article in press: January 23, 2018
Published online: February 27, 2018
Abstract

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.

Keywords: Liver cirrhosis, Spontaneous bacterial peritonitis, Spontaneous fungal peritonitis, Bacterial infections

Core tip: Spontaneous bacterial (SBP) and spontaneous fungal peritonitis (SFP) are infectious complications in patients with liver cirrhosis (LC). Renal impairment, severity of underlying liver dysfunction, and infections caused by multidrug-resistant (MDR) organisms are associated with a fatal prognosis in SBP. Antibiotic prophylaxis is recommended for patients with LC and with a high risk of developing SBP, gastrointestinal bleeding, or a previous episode of SBP, but the increase in the risk of infections caused by MDR organisms is of concern. Increased mortality of SFP compared with that of SBP may partially result from delayed diagnosis and starting of antifungal therapy.