Analysis of Prevalence of Spontaneous Bacterial Peritonitis in Cirrhotic Ascites in a Tertiary Care Centre in Northern Tamilnadu

Abstract

BACKGROUND Spontaneous bacterial peritonitis is defined as infected ascitic fluid in the absence of apparent intra-abdominal source of infection. Infections with more than one organism is likely to be associated with abdominal paracentesis, colonic perforation or intraabdominal source of infection. Infections among cirrhotic patients is often overlooked when compared to the attention given to its other complications. The objective of this study is to study the prevalence of spontaneous bacterial peritonitis in patients with Alcoholic liver cirrhosis within a tertiary care centre in Northern Tamilnadu. MATERIALS AND METHODS This was a cross-sectional study conducted in the Department of General Medicine in Govt. Vellore Medical College for a period of 6 months, which included 102 patients with cirrhosis of liver with ascites. Patients were diagnosed as a case of cirrhosis of liver with ascites on basis of clinical evaluation, biochemical investigations, ultrasonography and UGI scopy. All the patients were chronic alcoholics and were not on any antibiotics. All patients with ascites due to other causes viz. renal, tuberculosis, malignant pathology, cholelithiasis, collagen vascular diseases etc. were excluded. Patients who were on antibiotics prior to or on admission were excluded. Patients with obvious causes of intra-abdominal infection were excluded from the study. RESULTS 21 out of 102 patients, i.e. 20.59% had spontaneous bacterial peritonitis. Men (80.95%) more commonly presented with cirrhotic ascites when compared to women (19.05%) in our study. Ascitic fluid culture from 9 patients yielded positive results by bedside blood culture bottle inoculation. 12 patients (57.14%) were labelled as neutrocytic bacterascites. The most common organism cultured was E. coli (66.67%). CONCLUSION SBP is the common overlooked complication of ascites with prevalence common among male alcoholics in age group between 30-50 years with abdominal pain, the most common precursor symptom of SBP.