Nosocomial spontaneous bacterial peritonitis is associated with high mortality – a systematic review and meta-analysis

It is unclear if Nosocomial Spontaneous Bacteria Peritonitis (NSBP) is associated with higher mortality compared with community acquired spontaneous bacterial peritonitis. Database search from inception to May 2022 was conducted. The databases included MEDLINE, EMBASE, Cochrane registry of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus. Inclusion criteria were as follows: adult patients, age >18 years, with a diagnosis of NSBP. Pooled estimates of mortality were calculated following the restricted maximum likelihood method. The mortality rate between NSBP and CA-SBP was reported as odds ratio (OR) and 95% confidence interval (CI). Data synthesis was obtained using random effects meta-analysis. Heterogeneity was reported as I². A total of 482 unique titles were screened. Twenty-two articles were included. A total of 2,145 patients with NSBP were included. Patients were followed for a median of 90 days. The pooled mortality rate of NSBP was 52.51% (95% CI 42.77–62.06%; I² 83.72%). Seven studies compared the mortality outcome of patients with NSBP and CA-SBP. NSBP was significantly associated with a higher rate of mortality (OR 2.78, 95% CI 1.87–4.11; I² 36.00%). NSBP was associated with higher mortality rate compared to CA-SBP, which could be due to a higher rate of resistance organisms.

目前尚不明确医院获得性自发性细菌性腹膜炎（Nosocomial Spontaneous Bacteria Peritonitis, NSBP）相较于社区获得性自发性细菌性腹膜炎（community acquired spontaneous bacterial peritonitis, CA-SBP），是否会导致更高的死亡率。本研究检索了建库至2022年5月的相关文献，检索数据库涵盖MEDLINE、EMBASE、Cochrane对照试验注册库、Cochrane系统评价数据库及Scopus。纳入标准如下：年龄＞18岁的成年患者，且确诊为NSBP。本研究采用限制性最大似然法计算合并死亡率估计值，以比值比（odds ratio, OR）与95%置信区间（confidence interval, CI）报告NSBP与CA-SBP的死亡率差异。数据合成采用随机效应Meta分析，异质性以I²值进行报告。本研究共筛选出482条独立文献标题，最终纳入22项研究，共计纳入2145名NSBP患者，患者的中位随访时间为90天。NSBP的合并死亡率为52.51%（95%CI 42.77%~62.06%；I²=83.72%）。其中7项研究对比了NSBP与CA-SBP患者的死亡率结局，结果显示NSBP与更高的死亡率水平显著相关（OR=2.78，95%CI 1.87~4.11；I²=36.00%）。相较于CA-SBP，NSBP患者的死亡率更高，这一结果可能与耐药病原菌的检出率更高有关。