中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 40 Issue 2
Feb.  2024
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2024  >  40(2): 306-311

Clinical application value of a predictive model for the efficacy of third-generation cephalosporin in treatment of community-acquired spontaneous bacterial peritonitis

DOI: 10.12449/JCH240214
  • 1.

    Department of Hepatology，The Ninth Hospital of Nanchang，Nanchang 330002，China

  • 2.

    Department of Gastroenterology，Jiangxi Provincial Children’s Hospital，Nanchang 330006，China

Research funding:

Key Research and Development Program of Jiangxi Province (20181BBG78010)

More Information
  • Corresponding author: ZHU Longchuan， zlcy1984@sina.com （ORCID： 0000-0002-4461-6195）
  • Received Date: 2023-08-28
  • Accepted Date: 2023-10-16
  • Published Date: 2024-02-19
    Abstract
  •   Objective  To investigate the clinical application value of a predictive model for the efficacy of third-generation cephalosporin in the treatment of community-acquired spontaneous bacterial peritonitis （CASBP）.  Methods  This prospective study was conducted among 50 patients with liver cirrhosis and CASBP who were admitted to The Ninth Hospital of Nanchang from January 2021 to June 2022， and the patients were randomly divided into optimized treatment group and traditional treatment group， with 25 patients in each group. The patients in the optimized treatment group received ceftazidime or imipenem for initial treatment based on the above predictive model， and those in the traditional treatment group received ceftazidime for initial treatment， with the subsequent use of antibiotics adjusted based on the efficacy of initial treatment. The two groups were compared in terms of the response rate of initial treatment， cure rate on day 5， and 30-day mortality rate. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.  Results  All patients completed the study. The optimized treatment group had a significantly higher response rate of initial treatment than the traditional treatment group （88.0% vs 60.0%， χ2=5.094， P=0.024）， while there was no significant difference in the cure rate on day 5 between the two groups （80.0% vs 56.6%， χ2=3.309， P=0.069）. As for the patients who received ceftazidime for initial treatment， the optimized treatment group had a significantly higher response rate of initial treatment than the traditional treatment group （88.9% vs 60.0%， χ2=4.341， P=0.037）， while there was no significant difference in the cure rate on day 5 between the two groups （83.3% vs 56.0%， χ2=2.425， P=0.119）. There was no significant difference in 30-day mortality rate between the two groups （8.0% vs 20.0%， χ2=0.664， P=0.415）. For all patients， there was a significant association between response of initial treatment and cure on day 5 （odds ratio ［OR］=9.643， 95% confidence interval ［CI］： 2.292‍ — ‍40.564） and between cure on day 5 and 30-day mortality （OR=0.138， 95%CI： 0.023‍ — ‍0.813）.  Conclusion  This predictive model for efficacy helps clinicians to identify the patients who can benefit from third-generation cephalosporin treatment and improve the efficacy of third-generation cephalosporin in the initial empirical treatment of CASBP.

     

    • FullText(HTML)
  • loading
    • References(18)
  • [1]
    Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the management of ascites and complications in cirrhosis[J]. J Clin Hepatol, 2017, 33( 10): 1847- 1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003.

    中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南[J]. 临床肝胆病杂志, 2017, 33( 10): 1847- 1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003.
    [2]
    BIGGINS SW, ANGELI P, GARCIA-TSAO G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American association for the study of liver diseases[J]. Hepatology, 2021, 74( 2): 1014- 1048. DOI: 10.1002/hep.31884.
    [3]
    ZHU LC, WU W, ZOU B, et al. Efficacy predictors of third-generation cephalosporins in treating spontaneous bacterial peritonitis[J]. Medicine(Baltimore), 2022, 101( 40): e30164. DOI: 10.1097/MD.0000000000030164.
    [4]
    ZHU LC, WU W, ZOU B, et al. Establishment of a model for predicting the efficacy of third-generation cephalosporin in treatment of community-acquired spontaneous bacterial peritonitis[J]. J Clin Hepatol, 2022, 38( 11): 2499- 2504. DOI: 10.3969/j.issn.1001-5256.2022.11.012.

    朱龙川, 吴蔚, 邹波, 等. 第三代头孢菌素治疗社区获得性自发性细菌性腹膜炎的疗效预测模型[J]. 临床肝胆病杂志, 2022, 38( 11): 2499- 2504. DOI: 10.3969/j.issn.1001-5256.2022.11.012.
    [5]
    AITHAL GP, PALANIYAPPAN N, CHINA L, et al. Guidelines on the management of ascites in cirrhosis[J]. Gut, 2021, 70( 1): 9- 29. DOI: 10.1136/gutjnl-2020-321790.
    [6]
    JINDAL A, KUMAR M, BHADORIA AS, et al. A randomized open label study of‘imipenem vs. cefepime’ in spontaneous bacterial peritonitis[J]. Liver Int, 2016, 36( 5): 677- 687. DOI: 10.1111/liv.12985.
    [7]
    PUGH RN, MURRAY-LYON IM, DAWSON JL, et al. Transection of the oesophagus for bleeding oesophageal varices[J]. Br J Surg, 1973, 60( 8): 646- 649. DOI: 10.1002/bjs.1800600817.
    [8]
    KAMATH PS, WIESNER RH, MALINCHOC M, et al. A model to predict survival in patients with end-stage liver disease[J]. Hepatology, 2001, 33( 2): 464- 470. DOI: 10.1053/jhep.2001.22172.
    [9]
    JIN PH. Medical statistical methods[M]. 2nd ed. Shanghai: Fudan University Press, 2003: 469- 471.

    金丕焕. 医用统计方法[M]. 第2版. 上海: 复旦大学出版社, 2003: 469- 471.
    [10]
    FIORE M, GENTILE I, MARAOLO AE, et al. Are third-generation cephalosporins still the empirical antibiotic treatment of community-acquired spontaneous bacterial peritonitis? A systematic review and meta-analysis[J]. Eur J Gastroenterol Hepatol, 2018, 30( 3): 329- 336. DOI: 10.1097/MEG.0000000000001057.
    [11]
    LIN QT, ZHU HD. Establishment of the model for predicting the initial therapeutic effect of hospital-acquired methicillin-resistant staphylococcus aureus pneumonia[J]. Chin J Crit Care Med, 2022, 42( 5): 393- 400. DOI: 10.3969/j.issn.1002-1949.2022.05.004.

    林清婷, 朱华栋. 建立医院获得性耐甲氧西林金黄色葡萄球菌肺炎的初始治疗效果预测模型的研究[J]. 中国急救医学, 2022, 42( 5): 393- 400. DOI: 10.3969/j.issn.1002-1949.2022.05.004.
    [12]
    LI C, SU HB, LIU XY, et al. Clinical outcome of patients with acute-on-chronic liver failure and bacterial infection after 72 hours of anti-infective therapy[J]. J Clin Hepatol, 2019, 35( 1): 147- 152. DOI: 10.3969/j.issn.1001-5256.2019.01.028.

    李晨, 苏海滨, 刘晓燕, 等. 慢加急性肝衰竭合并细菌感染患者抗感染治疗72小时的效果及影响因素[J]. 临床肝胆病杂志, 2019, 35( 1): 147- 152. DOI: 10.3969/j.issn.1001-5256.2019.01.028.
    [13]
    LEE CH, KANG HJ, YU SY, et al. Initial treatment response and short-term mortality of spontaneous bacterial peritonitis in cirrhotic patients with hepatocellular carcinoma[J]. Sci Rep, 2023, 13( 1): 6067. DOI: 10.1038/s41598-023-32006-8.
    [14]
    PIANO S, FASOLATO S, SALINAS F, et al. The empirical antibiotic treatment of nosocomial spontaneous bacterial peritonitis: Results of a randomized, controlled clinical trial[J]. Hepatology, 2016, 63( 4): 1299- 1309. DOI: 10.1002/hep.27941.
    [15]
    YIM HJ, KIM TH, SUH SJ, et al. Response-guided therapy with cefotaxime, ceftriaxone, or ciprofloxacin for spontaneous bacterial peritonitis: A randomized trial: A validation study of 2021 AASLD practice guidance for SBP[J]. Am J Gastroenterol, 2023, 118( 4): 654- 663. DOI: 10.14309/ajg.0000000000002126.
    [16]
    SAFFO S, TO UK, SANTOIEMMA PP, et al. Changes in ascitic fluid polymorphonuclear cell count after antibiotics are associated with mortality in spontaneous bacterial peritonitis[J]. Clin Gastroenterol Hepatol, 2022, 20( 5): e1201- e1204. DOI: 10.1016/j.cgh.2021.07.019.
    [17]
    SARWAR S, TARIQUE S, WARIS U, et al. Cephalosporin resistance in community acquired spontaneous bacterial peritonitis[J]. Pak J Med Sci, 2019, 35( 1): 4- 9. DOI: 10.12669/pjms.35.1.17.
    [18]
    SANGLODKAR U, JAIN M, VENKATARAMAN J. Predictors of immediate and short-term mortality in spontaneous bacterial peritonitis[J]. Indian J Gastroenterol, 2020, 39( 4): 331- 337. DOI: 10.1007/s12664-020-01040-z.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(2)  / Tables(1)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (274) PDF downloads(42) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return