Spontaneous Bacterial Peritonitis In Ascites: A Prospective Study In A Tertiary Care Hospital 2737-2741
Department of Medicine
S.Nijalingppa Medical College
Bagalkot-587 102, Karnataka
Phone No.: 9480183063
Background: Spontaneous bacterial peritonitis is a common and fatal complication occurring in cirrhotic patients with ascites. It is defined as infected ascites in the absence of any recognisable secondary cause of infection.
Objective: To evaluate the relative frequency, clinical presentation and microbial spectrum of spontaneous bacterial peritonitis in ascites patients.
Design: A Hospital based prospective study carried out in patients with ascites.
Place And Duration Of Study: The study was conducted in the departments of Medicine and Biochemistry from August 2008- July 2009 at S.Nijalingappa Medical College and HSK hospital and Research Center, Bagalkot, Karnataka.
Material And Methods: 100 patients admitted to the Department of Medicine with the diagnosis of ascites were selected. They were divided into cirrhotic and non cirrhotic ascites cases. Ascitic fluid from these patients was analysed for cytology, culture/sensitivity and biochemical parameters. Based on these investigations, the cases were further categorized into the SBP (Spontaneous bacterial peritonitis), CNNA (Culture Negative Neutrocytic Ascites) and MNB (Monomicrobial non-Neutrocytic Bacterascites) groups. Statistical analysis was done by using the unpaired â€śtâ€ť test.
Results: 81 patients were cirrhotic and the rest of the 19 cases were non cirrhotic. Among the patients of cirrhotic ascites, SBP was diagnosed in 8 cases (9.81%) and CNNA and MNB were diagnosed in 3(3.7%) and 1(1.23%) cases, respectively. In the SBP group, Escherichia.coli was the most frequently cultured organism and it was isolated in 4 cases (50.0%), followed by Klebsiella pnuemoniae in 3(37.5%) cases and Pseudomonas aeruginosa in 1 (12.5%) case. In the CNNA group, the culture was negative, while in MNB one case was E.coli positive. Abdominal pain, hepatic encephalopathy and fever were the common presenting features in 75%, 75% and 62.5% cases in the 3 groups, respectively. The ascitic fluid protein was 0.92 Â± 0.25 gms/dl in the SBP group, 1.13 Â± 0.49 gms/dl in the CNNA group and 1.4gms/dl in MNB patients.
Conclusion: SBP is a fatal complication of cirrhosis with ascites. It has a heterogenous clinical presentation. Ascitic fluid should be analysed routinely in all cases of cirrhosis with ascites for the early detection of SBP.