FREQUENCY OF MICROBIAL SPECTRUM OF SPONTANEOUS BACTERIAL PERITONITIS IN ESTABLISHED CIRRHOSIS LIVER
AbstractBackground: Spontaneous bacterial peritonitis is one of the most frequent and serious complication inpatients with liver cirrhosis and ascites associated with high mortality. Empiric antibiotic therapyshould be initiated before the results of ascitic fluid cultures are available, guided by knowledge of themicrobial spectrum of spontaneous bacterial peritonitis in a particular population. Methods: This is adescriptive study which was carried out in the Department of Gastroenterology and Hepatology,Postgraduate Medical Institute Hayatabad Medical Complex, Peshawar from January 2007 toDecember 2007. Fifty consecutive patients of established cirrhosis liver with ascites presenting withsuspicion and or risk factors for spontaneous bacterial peritonitis were included in the study afterinformed consent. All selected patients were subjected to ascitic fluid tap. Twenty ml of ascitic fluidwas aspirated in a heparinised disposable syringe; out of it 10 ml was immediately inoculated intoblood culture bottle at bedside and sent for bacterial culture along with the remaining 10 ml for routinebiochemical and cytological examination. Results: Out of 50 patients, 28 (56%) were diagnosed tohave spontaneous bacterial peritonitis or its variants. Classic spontaneous bacterial peritonitis waspresent in 11 patients (39.28%), 16 (57.14%) patients were found to have culture negative neutrocyticascites and one patient (3.57%) had bacterascites. Out of 28 cases of spontaneous bacterial peritonitis12 samples of ascitic fluid showed positive culture reports. E. coli was the most frequently culturedorganism isolated in 8 (66.66%) cases, Streptococcus pneumonae in 2 patients (16.66%),Staphylococcus aurus and Klebsiella each in 1 case (8.33%). Conclusion: Spontaneous bacterialperitonitis and its variants is a common complication of liver cirrhosis with ascites. E. coli is the mostfrequent offending organism in these cases. Knowledge of the microbial spectrum of spontaneousbacterial peritonitis in a particular population is important for the selection of the most appropriateempiric antibiotic regimen.Keywords: Cirrhosis liver, Spontaneous bacterial peritonitis, Ascitic fluid culture
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