Features and Outcomes of Spontaneous Bacterial Peritonitis in Egypt, Single Center Experience

Abstract

Spontaneous bacterial peritonitis (SBP) is a serious complication of liver cirrhosis, with a recurrence rate up to 70% at 1 yr. Diagnosis of SBP is based on a positive ascitic fluid (AF) culture and/or a polymorph nuclear leukocyte count of >250 cells/μL. Third generation cephalosporins had been viewed as the drug of choice. Aim of the work: to study features, and outcomes of spontaneous bacterial peritonitis in National Liver Institute (Menofia University), a single center study. Methods: This work was conducted on 60 patients had SBP. All patient had AF analysis, bedside AF culture, Blood culture (BC), Serum albumin, Ascitic fluid gradient (SAAG). Results: The more severe the liver disease, as assessed by Child-Turcotte-Pugh (CTP score), the higher the possibility to have positivity of AF culture. Patient who had positive BC had significant rising of Creatinine. The pattern of infection in AF culture is close to that of BC, but Streptococci take the upper hand in BC and Staphylococcus in AF culture. Gram-positive organisms are more common in both AF and BC than gram negative. Mortality rate was higher in culture positive SBP patients 46.2%, and BC positive patients, 62.5%. In all positive cultures patients, Staph Species represents 44.8% with mortality rate of 42% of all mortalities. Most of them were resistant to cephalosporin 62.5%. Strep species represents 31% with mortality rate of 20%. E. coli represents 24.2% with mortality rate of 20%. Conclusion: The microbial pattern of organisms responsible for SBP has changed with predominance of gram-positive organisms. Pattern of microbial infection is similar in both blood and ascetic fluid culture, so BC results can be relied upon to guide therapy, in negative AF culture.