Incidence of spontaneous bacterial peritonitis in liver cirrhosis, the causative organisms and antibiotic sensitivity

ABSTRACT

To find out the incidence of spontaneous bacterial peritonitis in patients with liver cirrhosis having ascites, the causative organisms and their antibiotic sensitivity. This study was conducted in Medical Ward of Khyber Teaching Hospital, Peshawar from 1st June 2001 to 31 of March 2003. Patients having liver cirrhosis confirmed previously by histopathology and now presenting with fever with or without chills, abdominal discomfort, increasing abdominal distension, confusion and hepatic encephalopathy, were included. A total of 200 patients were studied. Out of 200 patients included, spontaneous bacterial peritonitis [SBP] was present in 102 patients. Classical SBP was present in 38.23%; Culture Negative Neutrocytic Ascites [CNNA] was present in 57.84% while Bacterascites was present in 03.92% of patients. E Coli was isolated in 58.13%, Streptococcus pneumoniae in 18.60%, Staphylococcus auras in 09.13%, Klebsiella in 09.13% and Acinetobacter in 04.65%. Out of 102 cases of SBP, blood cultures were positive in 21.56%, urine cultures in 15.68% and throat swabs in 10.78% of patients. E Coli was again the commonest organism isolated from blood cultures. All the organisms were sensitive to 3rd generation cephalosporins, and quinolones. Spontaneous bacterial peritonitis is quite a common complication of liver cirrhosis with ascites. Patients usually present with abdominal pain, abdominal tenderness, fever with or without rigors, jaundice, and hepatic encephalopathy. E Coli is the commonest organism followed by streptococcal pnaemoniae. Quinolones and 3rd generation cephalosporins are 100% effective in the management of spontaneous bacterial peritonitis