Spontaneous bacterial peritonitis in liver cirrhosis with ascites

The study was designed to elucidate the correlation of spontaneous bacterial peritonitis (SBP) with aetiology of liver cirrhosis, overall mortality, ascitic fluid and systemic microbial infections.

Sixty three patients with cirrhosis of the liver were included in this study. These patients were diagnosed on the basis of clinical evaluation, biochemical investigation, ultrasonography, ascitic fluid examination for protein, cells, pH, and bacterial culture.

SBP developed in 22 (34.92%) patients of cirrhosis. Culture positive SBP was present in 18 (81.81%) and culture negative neutrocytic ascitis (CNNA) in 4 (18.18%). In the culture positive group, 14 (77.7%) patients had monomicrobial bacterascites (MNB), the commonest organism being coagulase positive Staphylococcus aureus eight (44.44%) followed by E. coli (22.22%). Only 4 (22.22%) had infection by more than one organism. Direct bed side inoculation of ascitic fluid into blood culture bottle was a better method for bacterial yield than the conventional method of ascitic fluid culture (81.8% vs. 18.2%). Only 22.8% patients with SBP had ascitic fluid protein less than 1 gm%, ascitic fluid pH < 7.3 and polymorphonuclear cell count > 250/cmm.

Spontaneous bacterial peritonitis is common complication in Child Pugh class C cirrhosis. Alcoholic cirrhosis with SBP carries high mortality than their non-alcoholic group. The most common organisms isolated were coagulase positive Staphylococcus aureus followed by E. coli.