Presentation of a case with SBP infection before liver transplantation

Background and Aim : Recurrence of SBP has been reported to be ۶۹% in ۱ year. Norfloxacin۴۰۰ mg per day orally has been reported to successfully prevent SBP in (۱) patients with lowproteinascites and (۲) patients with prior SBP. Intermittent dosing of antibiotics to preventbacterial infections may be inferior to daily dosing due to the development of bacterial resistance)and thus daily dosing should preferentially be used.Methods : A ۵۷ Y/O woman Background: Cirrhosis due to PBC Complications: GI bleeding,Encephalopathy, SBP. Drug history was: Ursobil Aldactone, Lactulose and Ciprofloxacin. Shewas presented in our MDT meeting and has been listed for LT (with the first priority). The patientadmitted in Imamkhomeinin hospital two weeks later with Fever, abdominal pain and drowsiness.Her laboratory findings were compatible with SBP and she treated with piperacillin tazobactamand was discharged with ciprofloxacin after ۵ days.Results : Development of SBP in post-LT patients is associated with a poor prognosis In a studydone by Leong et al, ۱۸ patients (۸۵.۷%) who developed SBP ultimately died. The median timefrom the onset of ascites to death was ۲۱۴ days (range: ۱۰ – ۱۰۸۵ days). Following the first episodeof SBP, the median time to death was ۵۰.۵ days (range: ۴ – ۵۴۹ days ). Patients with Ascitic fluidPMN > ۲۵۰ cells/mm۳ should receive empiric antibiotic therapy e.g. Cefotaxime ۲ g/ ۸ h. OralOfloxacin (۴۰۰ mg BD) can be considered in patients without: Shock, grade ۲ hepaticencephalopathy, Cr> ۳ mg/dl.Conclusion : Development of SBP in post-LT patients may be associated with a poor prognosis.Early diagnosis and prompt management are two strategies to reduce mortality and morbidity ofpatients who received organ transplant while they have SBP.

کلیدواژه ها:

Liver Transplant ، Solid Organ Transplant ، Infectious Diseases ، Spontaneous bacterialperitonitis