Organisms causing spontaneous bacterial peritonitis in children with liver disease and ascites in Southern Iran

Abstract

INTRODUCTIONSpontaneous bacterial peritonitis (SBP) is defined as an ascitic fluid infection without a demonstrable intraabdominal cause [1] . It is a well known complication of cirrhosis in adults, occurring in 8% to 13% of patients [2][3][4][5] . The diagnosis is established by a positive ascitic fluid bacterial culture and an elevated ascitic fluid absolute polymorphonuclear leukocyte (PMN) count (≥ 2.5 × 10 5 /L). In adults, the organisms of SBP are usually gramnegative bacteria [2][3][4]6] , but they may differ in children [5,7] . The aim of the present study was to deter mine the causative agents of SBP in children with liver disease and ascites in our center. MATERIALS AND METHODSDuring a period of 2.5 years, from September 2003 to March 2006, 63 children with liver disease and ascites were prospectively studied in the Department of Pediatric Gastroenterology in Nemazee Hospital affiliated with Shiraz University of Medical Sciences, the major referral center in Southern Iran. Written consent was obtained from all parents after informing them about this study which was approved by the Ethics Committee of the University.Of the children involved in this study 12 had met the criteria for SBP (polymorphonuclear leukocyte count greater than 2.5 × 10 5 /L and positive ascitic fluid culture). In total 13 episodes of SBP were documented, of which two occurred with one patient, 4 mo apart. The patients and their parents answered a structured questionnaire, which included name, age, sex, clinical history, underlying liver diseases, history of antibiotic and diuretic use, history of previous variceal bleeding and episodes of SBP. All children had undergone a thorough physical examination.Serum albumin and glucose, urinalysis and urine culture were done in all patients. CONCLUSION: S. pneumoniae is the most common cause of SBP in the pediatric age group and we recommend a third generation cephalosporine (e.g., Ceftriaxione or Cefotaxime) for empirical therapy in children with SBP.

Diagnosis of spontaneous bacterial peritonitis in infants and children with chronic liver disease: A cohort study

“…Meanwhile, Dehghani et al, reported an incidence of SBP in 36.1% children with chronic end-stage liver disease [11]. The prevalence of SBP was 20.6% in a similar study conducted by Haghighat and colleagues [5]. A lower prevalence for SBP was noted in a retrospective study performed by Evans and colleagues.…”

Biliary atresia: A transplant perspective

“…Spontaneous bacterial peritonitis occurs in children with biliary atresia, although there is a surprising lack of comprehensive literature on this important complication in children with chronic liver disease 63–65. A high index of suspicion needs to be maintained for this entity in order to permit timely diagnosis and successful intervention.…”

Elevated C‐Reactive Protein and Spontaneous Bacterial Peritonitis in Children With Chronic Liver Disease and Ascites

“…Although Gram-negative organisms appear to predominate in adults with SBP (2), the limited literature in children with SBP implicates Gram-positive bacteria as the prevalent causative agents (3)(4)(5). Our objectives were to compare laboratory profiles of SBP and noninfected ascites (NIA) in a pediatric population with chronic liver disease and to determine the causative agents involved.…”