TITLE:
Features and Outcomes of Spontaneous Bacterial Peritonitis in Egypt, Single Center Experience
AUTHORS:
Khaled Gameel, Maha M. Elsabaawy, Mahmoud A. El Tahawy, Azza M. Abd-Elaziz, Imam A. Waked
KEYWORDS:
SBP, Ascites, Liver Failure, Bacterial Peritonitis
JOURNAL NAME:
Open Journal of Gastroenterology,
Vol.6 No.12,
December
21,
2016
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.