Spontaneous Bacterial Peritonitis in Patients of Cirrhosis of Liver with Ascites: A Study from Central India
Authors/Creators
- 1. Department of Medicine, People's College of Medical Sciences & Research Centre, Bhopal
Description
A 50 patients of cirrhosis were enrolled for the study. Overall incidence of SBP in our study population was 54%.
The mean age of presentation in our study was 44.11years.14 patients were diagnosed to have SBP or one of its variants with
a prevalence of 34.14%. Only ascitic fluid routine microscopy and inoculation of ascitic fluid into blood culture bottle was
found to be sufficient to diagnose SBP in most cases. Abdominal pain, tenderness and fever were strong indicators of ascitic
fluid infection. Majority of patients with SBP were Culture negative neutrocytic ascites (CNNA) (63%) with isolated PMN
count of >250 cells/mm3. Culture positivity was seen in 37% of patients of SBP out of which 30% were CNNAand 7% were
Mono-microbial non-neutrocytic bacterascites (MNBA). Escherichia coli and Staphylococcus aureus were the most
commonly isolated organisms. Peripheral leukocytosis was found to be a strong indicator for presence of ascitic fluid
infection. Classical symptoms and signs were absent in these patients and hence, definitive diagnosis could only be made by
ascitic fluid analysis and culture. Every patient of cirrhosis should be screened for SBP as delayed diagnosis can lead to fatal
outcome. Routine antibiotic coverage should be avoided for fear of resistance.
Files
6.pdf
Files
(63.6 kB)
| Name | Size | Download all |
|---|---|---|
|
md5:5b228c17eb438242bdd8c3595581ce81
|
63.6 kB | Preview Download |
Additional details
References
- 1. Garcia-Tsao G. Spontaneous bacterial peritonitis: Gastroenterology Clin NorthAm. 1992; 21:257-275.
- 2. Conn HO. SBP variant syndromes. South Med J, 1987;80;11:1343-1346.
- 3. Runyon BA. SBP associated with cardiac ascites. Am J of GE, 1984; 79:796
- 4. Jose Pinto Correria, Conn HO. SBP in cirrhosis endemic or epidemic? Med Clin of North America, 1975; 59:963.
- 5. Garcia-Tsao G., Current management of complications of cirrhosis and portal hypertension: varicealhaemo- rrhage, ascites, and spontaneous bacterial peritonitis. Gastroenterol. 2001; 120:726-748
- 6. Fernandez J, Navasa M, Gomez J, et al. Bactereial infections in cirrhosis: epidemiology changes with invasive procedures and norfloxacin prophylaxis. Hepatology 2002;35:140-148
- 7. Caly WR, Strauss E. Ak prospective study of bacterial infections in patients with cirrhosis. J Hepatol. 1993; 18:353-358
- 8. Pinzello G, Simonetti RG, Craxì A, Di Piazza S, Spanò C, Pagliaro L. Spontaneous bacterial peritonitis: a prospective investigation in predominantly nonalcoho- lic cirrhotic patients. Hepatology 1983;3: 545-549.
- 9. Filik L, Unal S. SBP in cirrhosis, frequency and predictive factors. Hepatology.1988;8;27.
- 10. Rawat N, Bhatnagar MK. Study of prognostic factors in spontaneous bacterial peritonitis in Indian population; J Assoc Physicians India. 2006; 53; 350.
- 11. Bhatnagar MK. To assess the role of serial ascitic fluid cell count in treatment of spontaneous bacterial peritonitis. JAssoc Phys India. 2006;53:350.
- 12. Mihas AA, Toussaint J, Hsu HS, Dotherow P, Achord JL. Spontaneous bacterial peritonitis in cirrhosis: clinical and laboratory features, survival, and prognostic indicators. Hepatogastroentererology 1992; 39:520-522.
- 13. Agarwal MP, Chaudhary BR, Banerjee BD, Kumar A. Ascitic fluid examination for the diagnosis of spontaneous bacterial peritonitis in cirrhotic Ascites. JIACM. 2008;9(1):29-32
- 14. Jain AP, Chandra LS, Gupta S, Gupta OP, Jajoo UN, Kalantri SP: Spontaneous bacterial peritonitis in liver cirrhosis with Ascites. J Assoc Physicians India. 1999 ;47(6):619-21.