Journal of Liver

Abstract

Retrospective Comparative Study of Spontaneous Peritonitis Associated with Fungal and Bacterial Infection in Patients with Liver Cirrhosis

Toru Shizuma

Objective: Although patients with liver cirrhosis (LC) have a high risk of developing bacterial and fungal infections, few studies have evaluated spontaneous fungal peritonitis (SFP) or fungiascites in this population. Accordingly, we conducted a retrospective comparative study of spontaneous peritonitis associated with fungal (SFP and fungiascites) or bacterial culture-positive ascites [spontaneous bacterial peritonitis (SBP) and bacterascites] in patients with LC.
Methods: This study enrolled 73 patients with LC and ascitic culture-positive spontaneous peritonitis, including four, three, 35, and 31 patients with SFP, fungiascites, culture-positive SBP, and bacterascites, respectively. We compared the laboratory findings, Child–Pugh scores, and 1-month mortality rates between patients with fungal disease, i.e., spontaneous peritonitis associated with fungal culture-positive ascites (SFP and fungiascites), and those with bacterial disease, i.e., spontaneous peritonitis associated with bacterial culture-positive ascites (culturepositive SBP and bacterascites).
Results: We observed no significant differences in the severity of underlying liver dysfunction and renal impairment between patients with fungal and bacterial disease. However, the 1-month mortality rate was significantly higher in patients with fungal disease than in those with bacterial disease (71.4%, 5/7 vs. 25.8%, 17/66; p= 0.038).
Conclusion: In our retrospective study population, spontaneous peritonitis caused by fungi (SFP and fungiascites) was associated with a significantly higher short-term mortality rate compared with that of spontaneous peritonitis caused by bacteria (culture-positive SBP and bacterascites).

Further studies are required to investigate the underlying mechanisms and determine the effects of antifungal therapy on mortality.