Spontaneous Bacterial Peritonitis among Cirrhotic Patients in Upper Egypt: Clinical and Bacterial Profiles

Abstract

Background: Spontaneous bacterial peritonitis (SBP) and its variants represent fatal and serious complications in cirrhosis patients with ascites. However, few detailed data are available regarding the clinical and bacteriological feature of SBP in our Locality. This work aimed to determine the predictors and variants of SBP, and the bacterial pathogens.

Methods: We prospectively analyzed clinical characteristics and bacteriological profiles of 150 cirrhotic patients with ascites.

Results: 53 (35.3%) patients had SBP. 29 (54.7%) patients found to be classical type, 19 (35.8%) patients found to be CNNA, and 5 (9.4%) patients found to have bacterascites. Patients with SBP have higher bilirubin, CRP, INR, MELD score, Child score, and turbid ascites while those with no SBP had significantly higher serum albumin and total proteins. The predictors for SBP were previous history of SBP (OR = 4.56, 95%CI = 1.22- 3.33; p = 0.02) and low albumin in the ascitic fluid (OR= 2.34, 95%CI = 2.01- 4.01; p = 0.03). The most frequently isolated organisms in the 34 patients who have positive culture were E. coli (41.1%) and Staph. aureus (35.3%) followed by Streptococcus (11.7%), Pseudomonas (5.9%) and Pneumococci (5.9%). In the current study, the frequency of gram positive organisms in combination was 52.9% (18/34).

Conclusion: SBP is a serious complication that occurred in cirrhotic patients with ascites so, early empirical antibiotic is a key strategy in improving the prognosis in these patients. The frequency of gram positive organisms in SBP is increasing. It is essential to perform periodic epidemiological and bacteriological surveillance to adapt treatment recommendations.