Cargando…
Spontaneous fungal peritonitis: Micro-organisms, management and mortality in liver cirrhosis-A systematic review
BACKGROUND: 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 neutr...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6669191/ https://www.ncbi.nlm.nih.gov/pubmed/31388401 http://dx.doi.org/10.4254/wjh.v11.i7.596 |
_version_ | 1783440328702820352 |
---|---|
author | Tariq, Tooba Irfan, Furqan B Farishta, Mehdi Dykstra, Brian Sieloff, Eric Martin Desai, Archita P |
author_facet | Tariq, Tooba Irfan, Furqan B Farishta, Mehdi Dykstra, Brian Sieloff, Eric Martin Desai, Archita P |
author_sort | Tariq, Tooba |
collection | PubMed |
description | BACKGROUND: 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. AIM: To determine the prevalence of fungal pathogens, management and outcomes (mortality) of SFP in critically ill cirrhotic patients. METHODS: 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. RESULTS: 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%. CONCLUSION: 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. |
format | Online Article Text |
id | pubmed-6669191 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-66691912019-08-06 Spontaneous fungal peritonitis: Micro-organisms, management and mortality in liver cirrhosis-A systematic review Tariq, Tooba Irfan, Furqan B Farishta, Mehdi Dykstra, Brian Sieloff, Eric Martin Desai, Archita P World J Hepatol Systematic Review BACKGROUND: 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. AIM: To determine the prevalence of fungal pathogens, management and outcomes (mortality) of SFP in critically ill cirrhotic patients. METHODS: 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. RESULTS: 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%. CONCLUSION: 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. Baishideng Publishing Group Inc 2019-07-27 2019-07-27 /pmc/articles/PMC6669191/ /pubmed/31388401 http://dx.doi.org/10.4254/wjh.v11.i7.596 Text en ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ 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. |
spellingShingle | Systematic Review Tariq, Tooba Irfan, Furqan B Farishta, Mehdi Dykstra, Brian Sieloff, Eric Martin Desai, Archita P Spontaneous fungal peritonitis: Micro-organisms, management and mortality in liver cirrhosis-A systematic review |
title | Spontaneous fungal peritonitis: Micro-organisms, management and mortality in liver cirrhosis-A systematic review |
title_full | Spontaneous fungal peritonitis: Micro-organisms, management and mortality in liver cirrhosis-A systematic review |
title_fullStr | Spontaneous fungal peritonitis: Micro-organisms, management and mortality in liver cirrhosis-A systematic review |
title_full_unstemmed | Spontaneous fungal peritonitis: Micro-organisms, management and mortality in liver cirrhosis-A systematic review |
title_short | Spontaneous fungal peritonitis: Micro-organisms, management and mortality in liver cirrhosis-A systematic review |
title_sort | spontaneous fungal peritonitis: micro-organisms, management and mortality in liver cirrhosis-a systematic review |
topic | Systematic Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6669191/ https://www.ncbi.nlm.nih.gov/pubmed/31388401 http://dx.doi.org/10.4254/wjh.v11.i7.596 |
work_keys_str_mv | AT tariqtooba spontaneousfungalperitonitismicroorganismsmanagementandmortalityinlivercirrhosisasystematicreview AT irfanfurqanb spontaneousfungalperitonitismicroorganismsmanagementandmortalityinlivercirrhosisasystematicreview AT farishtamehdi spontaneousfungalperitonitismicroorganismsmanagementandmortalityinlivercirrhosisasystematicreview AT dykstrabrian spontaneousfungalperitonitismicroorganismsmanagementandmortalityinlivercirrhosisasystematicreview AT sieloffericmartin spontaneousfungalperitonitismicroorganismsmanagementandmortalityinlivercirrhosisasystematicreview AT desaiarchitap spontaneousfungalperitonitismicroorganismsmanagementandmortalityinlivercirrhosisasystematicreview |