Prevalence of spontaneous bacterial peritonitis in liver cirrhosis with ascites

Abstract

IntroductionSpontaneous bacterial peritonitis (SBP) is a common bacterial infection in patients with cirrhosis and ascites requiring prompt recognition and treatment. The aim of this study was to determine the prevalence, and characteristics of SBP among in-patients with cirrhosis and ascites seen at our facility.MethodsThirty one patients with liver cirrhosis and ascites who were admitted into the Medical ward of the Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Nigeria from August 2009 to July 2010 were retrospectively studied. All the patients had abdominal paracentesis done within 48 hours of admission under aseptic condition and the data obtained were analyzed.ResultsThe mean age of the studied population was 62±9 years (age range 43-78 years). Of the 21 that developed SPB, culture positive SBP was present in 66.7% (14/21) while CNNA was found in 33.3% (7/21). The prevalence of MNB was 26% (8/31) in this study. Of those with SBP, 93% had monomicrobial infection with aerobic Gram negative bacilli being responsible in 66.7% of the cases with E.coli (70%) being the predominant organism followed by Klebsiella species. Gram positive organisms accounted for 33.3% with Streptococcal species (60%) being the predominant organism followed by Staphylococcus aureus (40%). Patients with SBP had significantly lower platelet count when compared with those without SBP, p < 0.05. Also, international normalization ratio (INR) was significantly higher in those patients with SBP compared with those without SBP, p < 0.05. The poor prognostic indicators found in this study were; low ascitic protein, hepatic encephalopathy, coagulopathy, renal dysfunction (creatinine >2mg/dl) and leukocytosis (p < 0.05).ConclusionIt is therefore imperative to do diagnostic abdominal paracentesis for cell count and culture in any patient with onset of ascites or cirrhotic patients with ascites and suggestive symptoms compatible or suggestive of SBP.

Spontaneous Bacterial Peritonitis (Sbp)

“…Bibi et al 17 from Karachi reported E.coli in 63.5 % SBP cases having liver cirrhosis which is close to our study results. Oladimeji et al 16 also reported 70 % E. coli predominating among causative organisms of SBP which is close to our findings.…”

“…A study by Sheikhbahaie et al 15 also reported male gender predominance with male: female ratio was 1.25:1 which is in compliance with our study results. Oladimeji et al 16 also reported male gender predominance with 54.8%. In our study, E.coli was noted in 135 (73.8%), Staph.…”

Current concepts and future strategies in the antimicrobial therapy of emerging Gram-positive spontaneous bacterial peritonitis

“…In an Egyptian prospective cohort, the burden of GPB turned out to be as high as 73.2%, namely 30 out of 41 episodes, including 10 cases by Listeria monocytogenes [ 23 ]. In contrast, a retrospective study conducted in Nigeria, which reviewed medical records from August 2009 to July 2010, showed a much smaller proportion of GBP, which although not marginal was equal to 31.8% (7/22)[ 24 ].…”

The pattern of microbial flora in Spontaneous bacterial peritonitis in Cirrhotic patients

“…15 Despite an improvement in patient care, mortality after a single episode of SBP is estimated to be 32.5% at 1 month and 66.2% after 1 year. 16 Without prophylactic antibiotics; two-thirds of these patients have recurrences of infection within 12 months. 17 Patients of cirrhosis with higher serum bilirubin, Child-Pugh stage C, and thrombocytopenia are more likely to develop SBP.…”