Background and objectives: Spontaneous bacterial peritonitis (SBP) is a frequent complication in patients with chronic liver disease and ascites. This can develop slowly and insidiously or remain clinically unrecognized until the appearance of symptoms. The mortality rate after a single episode ranges from 20 to 40%, and early diagnosis is required for adequate treatment and prevention of new episodes. The aim was to study the clinicobacteriological profile of SBP and its variants in patients of cirrhosis.
Materials and methods: This prospective study was conducted on cirrhotic patients with ascites admitted in a tertiary care hospital. Basic demographics, symptoms, and clinical signs of patients were recorded. Diagnostic paracentesis was done for ascitic fluid cytology and culture. Identification and antimicrobial susceptibility of the isolates was done in VITEK system.
Results: Of a total of 113 cirrhotic patients, 58 (51.3%) were diagnosed with SBP. Culture-negative neutrocytic ascites (CNNA) was the commonest presentation. The most common symptoms were abdominal distension followed by fatigue, anorexia, and jaundice. Majority of patients belonged to Child- Pugh's Grade C. Of 58 cases of SBP, 22 were culture positive. Gram-negative isolates were predominant (77.3%). Escherichia coli was the commonest isolate. Gram-negative isolates were highly susceptible to colistin followed by tigecycline, amikacin, and carbapenems; 59% of the isolates were multidrug resistant (MDR) and 13.6% were extensively drug resistant (XDR).
Interpretation and conclusion: Prevalence of SBP in cirrhotic patients was 51.3% and Gram-negative isolates were predominant. Ascitic fluid culture and susceptibility testing can lead to accurate diagnosis of SBP and can guide for treatment as resistance to antibiotic is common.
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