The Prevalence and Causative Bacteria of Spontaneous Bacterial Peritonitis in Patients with Ascites Due to Liver Cirrhosis

The Prevalence and Causative Bacteria of Spontaneous Bacterial Peritonitis in Patients with Ascites Due to Liver Cirrhosis
Mostafa M. Ragheb* Hassan Nasr El Eslam Mohamed**, Hamdy A. Selim***, Ahmed M. Ragheb, Fadia M Attia****, Adel A Hassan* and Ahmed G. Salem*.
Faculty of Medicine, Suez Canal University, departments of * Endemic and Infectious Diseases, **Microbiology and Immunology and ***Internal Medicine and ****Clinical Pathology.
Faculty of Medicine, Al Azhar University, department of Clinical Pathology.
Abstract
Introduction: Spontaneous bacterial peritonitis (SBP) is a common and severe complication in cirrhotic patients with ascites. It occurs in 10-30% of patients admitted to hospitals causing high mortality. Aim of Work: This descriptive cross–sectional study aimed to determine the prevalence of SBP, the causative organisms and their antibiotic sensitivity. Subjects and Methods: The study included 198 patients with cirrhotic ascites admitted to Suez Canal University Hospital (SCUH) from May to December 2006. All were subjected to clinical assessment and imaging by abdominal ultrasound. Ascitic fluid (AF) examination included cell count, total proteins, culture and antibiotic sensitivity. SBP was diagnosed when the number of polymorphonuclear cells was >250/cmm in AF. Results: SBP was diagnosed in 20.4% (40 patients). Cultures were positive in 23 (11.6%) patients and revealed gram negative bacilli in 16 patients (69.9%) and gram positive cocci was isolated in 30.1% (7 patients). Escherichia coli were found in 52.2%, Streptococci (17.4%), Staphylococci (13%) and Klebsiella (13%) and Citrobacter (4.3%). All gram positive bacteria were sensitive to amoxicillin–clavulanic acid, levofloxacin and ampicillin–sulbactam compared to 85.7% sensitivity for cefotaxime, ceftriaxone and ofloxacin and 61.4% sensitivity for ciprofloxacin. For gram negative bacteria, the sensitivity was 100% for cefotaxime, 87.5% for ampicillin–sulbactam and 93.8% for the other antibiotics. SBP was significantly associated with higher pulse rate (89.8±6.2/min) and body temperature (37.8±0.6 ºC), spider nevi (60%), abdominal tenderness (77.5%), higher mean of total leukocytic count in peripheral blood (7,700±6,200/cmm), lower mean of serum total proteins and albumen (5.7±0.8 and 2.1±0.3 gram/dl respectively), prolonged prothrombin time (80%) and higher Child score (12.6±1.5). In the ascitic fluid, SBP was also significantly associated with significantly higher total leukocytic count (2987.5±5012.7) and lower mean total proteins (1.0±0.2gm/dl). Multivariate analysis revealed that high Child Pugh score and AF total protein levels of

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