Bacterascites: a variant of spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis is diagnosed when [a] the ascitic fluid culture is positive, [b] the ascitic fluid neutrophil count is > 250 cells/mm[3], and [c] there is no evident intra-abdominal surgically treatable source of infection. Few details are available regarding the variant of ascitic fluid infection in which the culture grows bacteria but the neutrophil count is < 250 cell/mm[3]. This prospective study includes 203 predominantly HBs Ag positive cirrhotic patients with ascites. Spontaneous bacterial peritonitis [SBP], culture negative neutrocytic ascites [CNNA], and bacterascites [BA] were identified in 12.81%, 5.42% and 6.40% patients respectively. Peritonitis-related signs or symptoms were present in 61.50% of patients with bacterascites. Clinical and laboratory data of patients with symptomatic BA, SBP and CNNA were almost similar. In contrast, patients with symptomatic BA had significantly higher levels of serum total bilirubin and prolonged prothrombin time and lower levels of ascitic fluid total protein than asymptomatic BA. There was no statistically significant difference between SBP and bacterascites regarding bacterial flora. All patients with SBP, CNNA or symptomatic BA received antibiotic treatment immediately after paracentesis while patients with asymptomatic BA were followed up clinically without treatment. Repeat paracentesis revealed no evidence of SBP or CNNA. In conclusion, 6.40% of cirrhotic patients with ascites developed bacterascites, 61.50% were symptomatic and 38.50% were asymptomatic. Symptomatic BA might be a SBP variant, while asymptomatic BA might represent transient colonization of ascitic fluid with bacteria