Spontaneous bacterial peritonitis is a serious event in patients with liver cirrhosis and associated with significant morbidity and mortality. There are three forms of SBP i.e. culture negative neutrocytic ascites, monomicrobial non-neutrocytic bacterascites and polymicrobial bacterascites. Most common causative organisms of SBP are E. coli, streptococcus pneumonia and klebsiella. It can present in various ways like abdominal pain, increase in abdominal distension, fever, and encephalopathy or even with gastroenteritis. Liver cirrhosis has multifactorial etiology and most common causes in our country are hepatitis C and hepatitis B. Etiology of liver ...view middle of the document...
It included 41 (51%) male patients and 39 (49%) female patients. Mean age was 53.05 years (SD ±6.82)
Out of 80 patients 66(82%) were not taking any prophylaxis while 14(18%) were taking prophylaxis. Among these 38(47%) patients were culture positive while 42(53%) were culture negative. Out of these 20(52.63%) were having gram negative and 14 (36.84%) were having gram positive growth. Most of these organisms were resistant to ceftazidim, cefoperazone and augmentin while were sensitive to levofloxacine, ceftriaxone, cefotaxime and ciprofloxacin.
E .coli, streptococcus pneumonia and klebsiella were the most common organisms causing SBP and were sensitive to levofloxacin, ceftriaxone, ciprofloxacin and cefotaxime and resistant to ceftazidim, cefoperazone and augmentin.
Spontaneous bacterial peritonitis, encephalopathy, portal hypertension, culture and sensitivity and resistance
Spontaneous bacterial peritonitis (SBP) is a bacterial infection of ascitic fluid in patients with decompensated cirrhosis in the absence of evident intra-abdominal infection.1 Hepatitis C virus infection is the leading cause of cirrhosis in Pakistan.2. Seroprevalence of HCV infection is found in 4- 12.5% of the healthy persons in our population and this carrier rate increases with the increasing age3. The carrier rate of hepatitis B surface antigen is 1.5- 2.1%4.
A study from Rawalpindi shows that 90% of patients with chronic liver disease and 74% cirrhotic patients had evidence of Hepatitis B virus (HBV), hepatitis C virus (HCV) or co-infection.5 In Pakistan and in Western countries the most common cause of portal hypertension is cirrhosis of liver.6, 7. Portal hypertension is one of the most serious complications of cirrhosis and ranks amongst the top ten leading causes of death world wide.8
The diagnosis is established by positive ascitic fluid culture or an elevated ascitic fluid total leukocyte count >500 cells/mm3 or absolute polymorphonuclear leukocyte (PMN) count ≥ 250 cells /mm3. A clinical diagnosis of SBP without paracentesis is not adequate. Abdominal paracentesis should be done in new onset ascites and patients with clinical deterioration and suspicion of SBP. Asymptomatic spontaneous bacterial peritonotis can be the first presentation of ascites in chronic liver disease patients. It is suggested that this condition should be actively sought in all chronic liver disease patients who develop ascites for the first time9.
Gram negative organisms like Escherichia coli, Klebsiella are more commonly found in SBP than gram positive organisms which have translocated from the bowel. Anaerobes are rarely isolated by culture of ascitic fluid which is the gold standard test for the diagnosis of SBP. There are trials showing bacterial growth in about 50% of cases when ascitic fluid is cultured by older methods as compared to approximately 80% when ascitic...