SPONTANEOUS BACTERIAL PERITONITIS

Abstract

Objective: To evaluate the prevalence, diagnostic criteria and microbial
spectrum of spontaneous bacterial peritonitis (SBP) and its variants in cirrhotic patients with ascites. Design: A hospital
based prospective study carried out in cirrhotic patients with ascites. Place and duration of Study: The study was
conducted in the Department of Medicine Military Hospital Rawalpindi during October 2000 to March 2002. Subject
and Methods: One hundred and eighty consecutive patients of cirrhotic liver between the ages of 20-65 years
presenting with ascites reporting to outdoor patient department of Military Hospital Rawalpindi were included in the
study. The diagnosis of cirrhosis was made on history, clinical examination and the ultrasonographic findings. These
patients were subjected to ascites fluid tap and the patients were divided into SBP and non-SBP groups in the light of
results of ascitic fluid routine examination and culture. The SBP group was further categorized into culture positive SBP,
culture negative neutrocytic ascites (CNNA) and bacterascites (BA) on the basis of culture results and total leukocyte
count, absolute polymorphonuclear leukocyte count per cubic mm of ascitic fluid. Results: The study included 144
males and 36 females having cirrhosis with ascites. The mean age of these patients was 52.32±7.87 years. On the
basis of routine examination and culture of tapped ascitic fluid from these cases 57 of 180(31.66%) patients were
diagnosed to have SBP or its variants. In addition to classic SBP in 18(31.58%) patients, its variants namely culture
negative neutrocytic ascites and bacterascites were detected in 37(64.92%) and two (3.5%) cases respectively. E. coli
was the most frequently cultured organism. It was isolated in 12 cases of SBP (60%). In 4 cases (20%) Klebsiella was
cultured whereas Proteus mirabilus and Streptococcus were reported in two cases (10%) each. Conclusion: This study
indicates that spontaneous bacterial peritonitis is common and potentially fatal complication in cirrhotic patients with
ascites. E. coli is the most frequent offending organism.