Spontaneous Bacterial peritonitis in Patients with Liver Cirrhosis and Ascites: Antimicrobial Sensitivity Pattern

Abstract

Spontaneous bacterial peritonitis (SBP) is an acute bacterial infection of ascitic fluid. Generally, no source of the infecting agent is easily identifiable, Spontaneous bacterial peritonitis is a well-known and warning complication in patients with cirrhosis. Of patients with cirrhosis who have spontaneous bacterial peritonitis, 70% are Child-Pugh class C. In these patients, the development of spontaneous bacterial peritonitis is associated with a poor long-term prognosis. This study was carried out on 80 cirrhotic patients from AIN SHAMS university hospitals and Ahmed Maher Teaching hospital underwent ascetic fluid analysis for PMN cell count and culture\sensitivity. All patients PMN cell count was over 250 cells/µL, 30 patients (37.5%) their culture\sensitivity were negative which is a large variant of SBP called culture negative neutrocytic ascitis. 50 patients (62.5%) their culture\sensitivity were positive. for gram negative organisms (82%), E.coli (53.66%) mostly sensitive to cefotaxime (80%), ceftriaxone (87.50%), cefoperazone (76.92%) Out of the 22 E.coli 4 (18.18%) were multidrug resistant, 3 (13.64%) were extensive drug resistant. Any patient with liver cirrhosis and ascites complain of abdominal pain, vomiting, fever or disturbed conscious level should undergo ascetic fluid analysis for PMN cell count and culture\sensitivity. If PMN cell count more than 250 cells/µL should start empirical third generation cephalosporin antimicrobial treatment for 10 to 14 days even if culture\sensitivity result is negative. Amikacin & cefepime should be considered in empirical antimicrobial therapy in spontaneous bacterial peritonitis with dose adjustment according to createnin clearance.