FREQUENCY OF MICROBIAL SPECTRUM OF SPONTANEOUS BACTERIAL PERITONITIS IN ESTABLISHED CIRRHOSIS LIVER
Abstract
Background: Spontaneous bacterial peritonitis is one of the most frequent and serious complication inpatients with liver cirrhosis and ascites associated with high mortality. Empiric antibiotic therapy
should be initiated before the results of ascitic fluid cultures are available, guided by knowledge of the
microbial spectrum of spontaneous bacterial peritonitis in a particular population. Methods: This is a
descriptive study which was carried out in the Department of Gastroenterology and Hepatology,
Postgraduate Medical Institute Hayatabad Medical Complex, Peshawar from January 2007 to
December 2007. Fifty consecutive patients of established cirrhosis liver with ascites presenting with
suspicion and or risk factors for spontaneous bacterial peritonitis were included in the study after
informed consent. All selected patients were subjected to ascitic fluid tap. Twenty ml of ascitic fluid
was aspirated in a heparinised disposable syringe; out of it 10 ml was immediately inoculated into
blood culture bottle at bedside and sent for bacterial culture along with the remaining 10 ml for routine
biochemical and cytological examination. Results: Out of 50 patients, 28 (56%) were diagnosed to
have spontaneous bacterial peritonitis or its variants. Classic spontaneous bacterial peritonitis was
present in 11 patients (39.28%), 16 (57.14%) patients were found to have culture negative neutrocytic
ascites and one patient (3.57%) had bacterascites. Out of 28 cases of spontaneous bacterial peritonitis
12 samples of ascitic fluid showed positive culture reports. E. coli was the most frequently cultured
organism isolated in 8 (66.66%) cases, Streptococcus pneumonae in 2 patients (16.66%),
Staphylococcus aurus and Klebsiella each in 1 case (8.33%). Conclusion: Spontaneous bacterial
peritonitis and its variants is a common complication of liver cirrhosis with ascites. E. coli is the most
frequent offending organism in these cases. Knowledge of the microbial spectrum of spontaneous
bacterial peritonitis in a particular population is important for the selection of the most appropriate
empiric antibiotic regimen.
Keywords: Cirrhosis liver, Spontaneous bacterial peritonitis, Ascitic fluid culture
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