Title: A Study on Clinical and Laboratory Features of Spontaneous Bacterial Peritonitis in Chronic Liver Disease

Author: Dr Archana Bhat

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i4.202

Abstract

Objective: To determine the clinical and laboratory features, bacterial profile and antibiotic sensitivity pattern of Spontaneous Bacterial Peritonitis (SBP) in Chronic Liver Disease (CLD) patients presenting at a tertiary care hospital of Goa medical college hospital

Study Design: Cross-sectional study. This study was done in department of medicine Goa medical college hospital, Panaji, Goa.

Methodology: CLD patients with ascites were recruited from Goa medical college hospital. Basic demographics, symptoms and clinical signs of patients were recorded. Patients with the history of antibiotic use within last 3 days or any intra-abdominal source of infection were excluded. Diagnostic paracentesis was done for ascitic fluid detailed report (D/R) and culture. Blood sample was collected for total leukocyte count, serum proteins and billirubin levels.

Results: Out of a total 100 CLD patients, 27 (27%) were diagnosed with SBP, Nine (33.7%) patients presented with classical SBP, 12 (44.4%) had culture negative neutrocytic ascites and 6 (22.2%) had bacterascites. Fever, abdominal tenderness and constipation were common in SBP patients. Ascitic fluid culture was positive in 15 (55.5%) patients. E. coli (63%) was the predominant pathogen followed by Enterococcus species (15%). Resistance was high against cephalosporins (78%) and fluoroquinolones (69.6%) and least against amikacin (13%) and meropenem (12%).

Conclusion: Ascitic fluid D/R and culture together can lead to the accurate diagnosis of SBP and can guide for the right antibiotic choice as resistance to commonly prescribed antibiotic is common in such patients.

Keywords: Chronic liver disease. Spontaneous bacterial peritonitis. Ascitic fluid. CNNA. Bacterascites. SAAG.

References

1.      Ginés P, Quintero E, Arroyo V, Terés J, Bruguera M, Rimola A. Compensated cirrhosis: natural history and prognostic factors. Hepatology 1987; 7:122-8.

2.      Biecker E. Diagnosis and therapy of ascites in liver cirrhosis. World J Gatroenterol 2011; 17:1237-48.

3.      Alaniz C, Regal RE. Spontaneous bacterial peritonitis; a review of treatment options. P&T 2009; 34:204-10.

4.      EASL. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome in cirrhosis. J Hepatol 2010; 53:397-417.

5.      Bandy SM, Tuttle A. Spontaneous bacterial peritonitis. E-Medicine from Web Med; 2006.

6.      Riggio O, Angeloni S. Ascitic fluid analysis for diagnosis and monitoring of spontaneous bacterial peritonitis. World J Gastroenterol 2009; 15:3845-50.

7.      Caruntu FA, Banea L. Spontaneous bacterial peritonitis: pathogenesis, diagnosis and treatment. J Gastroentest Liver Dis 2006; 15:51-6.

8.      Koulaouzidis A, Karagiannidis A, Tan WC. Spontaneous bacterial peritonitis. Postgrad Med J 2007; 83:379-83

9.      Kumar YS, Vikrant K. Ascites in childhood liver disease. Indian J Pediatr 2006; 73:819-24.

10.  Tahir M, Khan MB, Ahmed M. Spontaneous bacterial peritonitis. Pak Armed Forces Med J 2007; 1:15-8.

11.  Puri AS, Puri J, Ghoshal UC. Frequency, microbial spectrum and outcome of spontaneous bacterial peritonitis in North India. Ind J Gatroenterol 1996; 15:86-9.

12.  Vieira SM, Matte U, Keling CO. Infected and non infected ascites in pediatric patients. J Pediatr Gastrnterol Nutr 2005; 40:289-94.

13.  Fernandez J, Navasa M, Gómez J. Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology 2002;  35:140-8.

14.  Kamani L, Mumtaz K, Ahmed US. Outcomes in culture positiveand culture negative ascitic fluid infection in patients with viral cirrhosis: cohort study. BMC Gastroenterol 2008, 8:59-64.

15.  Evans LT, Kim WR, Poteruchs JJ. Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites. Hepatology 2003; 37:897-901.

16.  Ahmad M, Ali AA, Mumtaz M. Spontaneous bacterial peritonitis; microbiological analysis of ascitic fluid in patients with complicated liver cirrhosis. Prof Med J 2011; 18:557-61.

17.  Caruntu FA, Banea L. Spontaneous bacterial peritonitis: pathogenesis, diagnosis, treatment. J Gastrointest Liver Dis 2006; 15:51-6.

18.  Beg M, Hussain S, Ahmad N. Serum/ascites albumin gradient in differential diagnosis of ascites. J Indian Acad Clinic Med 2001; 2:51-4.

19.  Agarwal MP, Choudhury BR, Banerjee BD. Ascitic fluid examination for diagnosis of spontaneous bacterial peritonitis in cirrhotic ascites. JIACM 2008, 9:29-32.

20.  Thiele GB, Marcos da Silva O, Fayad L, Lazzarotto C, Ferreira MA, Marconcini ML, et al. Clinical and laboratory features of spontaneous bacterial peritonitis in Southern Brazil. Sao Paulo Med J 2014; 132:1324698.

21.  Nouman S, Hussain A, Hussain M. Frequency of spontaneous bacterial peritonitis in chronic liver disease. Annals 2010; 16:112-5.

22.  Pawar GP, Gupta M, Satija VK. Evaluation of culture techniques for detection of spontaneous bacterial peritonitis in cirrhotic ascites. Indian J Gastroenterol 1994; 13:139-40.

23.  Khan AG, Khan H, Khattak AK, Amin M. Microbial spectrum of spontaneous bacterial peritonitis in patients with cirrhosis and ascites. Pak J Gastroenterol 2012; 26:26-9.

24. Kim SU, Chon YE, Lee CK, Park JY, Kim do Y, Han KH, et al.Spontaneous bacterial peritonitis in patients with hepatitis Brelated liver cirrhosis: community acquired versus nosocomial. Yonsei Med J 2012; 53:328-36.

Corresponding Author

Dr Archana Bhat

Assistant Professor, Department of Medicine, Fr Mullers College Mangalore India