SPONTANEOUS BACTERIAL PERITONITIS

Objective: To evaluate the prevalence, diagnostic criteria and microbialspectrum of spontaneous bacterial peritonitis (SBP) and its variants in cirrhotic patients with ascites. Design: A hospitalbased prospective study carried out in cirrhotic patients with ascites. Place and duration of Study: The study wasconducted in the Department of Medicine Military Hospital Rawalpindi during October 2000 to March 2002. Subjectand Methods: One hundred and eighty consecutive patients of cirrhotic liver between the ages of 20-65 yearspresenting with ascites reporting to outdoor patient department of Military Hospital Rawalpindi were included in thestudy. The diagnosis of cirrhosis was made on history, clinical examination and the ultrasonographic findings. Thesepatients were subjected to ascites fluid tap and the patients were divided into SBP and non-SBP groups in the light ofresults of ascitic fluid routine examination and culture. The SBP group was further categorized into culture positive SBP,culture negative neutrocytic ascites (CNNA) and bacterascites (BA) on the basis of culture results and total leukocytecount, absolute polymorphonuclear leukocyte count per cubic mm of ascitic fluid. Results: The study included 144males and 36 females having cirrhosis with ascites. The mean age of these patients was 52.32±7.87 years. On thebasis of routine examination and culture of tapped ascitic fluid from these cases 57 of 180(31.66%) patients werediagnosed to have SBP or its variants. In addition to classic SBP in 18(31.58%) patients, its variants namely culturenegative neutrocytic ascites and bacterascites were detected in 37(64.92%) and two (3.5%) cases respectively. E. coliwas the most frequently cultured organism. It was isolated in 12 cases of SBP (60%). In 4 cases (20%) Klebsiella wascultured whereas Proteus mirabilus and Streptococcus were reported in two cases (10%) each. Conclusion: This studyindicates that spontaneous bacterial peritonitis is common and potentially fatal complication in cirrhotic patients withascites. E. coli is the most frequent offending organism.