• Marco Fiore, Paolo Chiodini, Vincenzo Pota, Pasquale Sansone, Maria B Passavanti, Sebastiano Leone, Caterina Aurilio, and Maria C Pace.
• Department of Anesthesiological, Surgical and Emergency Sciences, "Luigi Vanvitelli" University of Campania, Naples, Italy - marco.fiore@hotmail.it.
• Minerva Anestesiol. 2017 Dec 1; 83 (12): 1309-1316.

IntroductionSpontaneous fungal peritonitis (SFP) is an infection of ascitic fluid occurring in cirrhotic patients. SFP prevalence varies from 0% to 41% of patients with spontaneous peritonitis (SP) and a positive ascitic fluid culture. Cirrhotic patients with SFP who fail to show improvement with empirical antibiotic therapy, before the identification of the fungal pathogen, have high mortality (89.5-100%). Although the weight of the disease is so dramatic, more recent guidelines on infections in cirrhosis do not consider SFP management. The aim of this meta-analysis was to investigate the association between hospitalization (at least 48-72 hours after admission) and risk of SFP.Evidence AcquisitionA literature search was performed on PubMed, Scopus and Web of Science to identify relevant studies published up to March 2, 2017. Only observational studies that specify the etiology of SP were included. Data were pooled using risk difference as a summary measure and corresponding 95% confidence interval (CI).Evidence SynthesisThirteen cohort studies were included in the meta-analysis (12 retrospective and one prospective). A pooled risk difference, using a random effects model, of nosocomial versus non-nosocomial SFP was 2.9% (95% CI, 0.4% to 5.3%, P=0.024) with a no significant heterogeneity among studies (P=0.090, I²=37%).ConclusionsThis meta-analysis suggests that hospitalization is related to a significant increase of SFP risk.

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