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  • 1 Debreceni Egyetem, Általános Orvostudományi Kar, Debrecen, Nagyerdei krt. 98., 4032
  • | 2 Debreceni Egyetem, Általános Orvostudományi Kar, Debrecen
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Absztrakt:

A spontán bakteriális peritonitis megjelenésére ascitessel járó májzsugorban szenvedőknél számíthatunk. A kórokozók intestinalis bakteriális transzlokáció útján a véráramba jutnak, majd az ascitesbe kerülve elszaporodnak. A betegség diagnózisa az ascites megemelkedett neutrofilszámának igazolásán alapszik (>0,25 G/L). A tenyésztés gyakran álnegatív, az antibiotikum-érzékenység meghatározása miatt mégis fontos. Kezelésére stabil betegekben iv., majd orálisan alkalmazott ciprofloxacint vagy amoxicillin/klavulánsavat ajánlanak, súlyosabb állapotban III. generációs cefalosporint. Nosocomialis infekció esetén a gyakoribb Gram-pozitív és antibiotikum-rezisztens patogének okozta fertőzés miatt imipenemet vagy meropenemet célszerű választani. Profilaxisként norfloxacint javasolnak, bár a fokozódó rezisztenciával számolni kell. Gastrointestinalis vérzés esetén öt napon át alkalmazott norfloxacin, súlyos májelégtelenek vérzése esetén ceftriaxon adása indokolt. Tartós antibiotikum-profilaxist (napi 400 mg norfloxacin) – primer prevencióként – alacsony ascitesösszfehérje-szintű, előrehaladott májzsugorosok számára ajánlanak, míg szekunder prevenció gyanánt minden spontán bakteriális peritonitisből felépült beteg számára indokolt adni. Nem mindenki ért egyet a tartós antibiotikum-profilaxissal. A cikk megírásának ösztönzője volt az a mindennapi tapasztalat, hogy a kórképpel kapcsolatos ismeretek nem eléggé állnak a cirrhosis kezelésének középpontjában. Orv. Hetil., 2017, 158(2), 50–57.

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