• Amjad Zaman
  • Rahida Kareem
  • Rashid Mahmood
  • Khalid Hameed
  • Ejaz Muhammad Khan


Background: 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


Christou L, Papas G, Falagas ME. Bacterial infection-related

morbidity and mortality in cirrhosis. Am J Gastroenterol


Ascites in Sherlock S, Dooley J. Diseases of the liver and

biliary system. 11 ed. Oxford, England: Blackwell Science;

p. 127–46.

Iqbal M, Jamal S, Rathore OI, Qureshi MA. SBP in

hospitalized chronic liver disease patients. J Rawal Med Coll


Jaffary W, Shah H, Hamid S. Spontaneous bacterial

peritonitis. Specialists 1992;8(3):33–8.

Rubinstein P, Morales M, Pandiani A. Bagattini JC.

Spontaneous bacterial peritonitis in hepatic cirrhosis with

ascites: incidence, bacteriology and mortality in Uruguay.

Acta Gastroenterol Latinoam 2001;31(4):307–12.

Burroughs AK, Westaby D. Liver, billiary tract and

pancreatic diseases, In: Kumar P, Clark M. eds. Clinical

Medicine. A Text Book for Medical Students and Doctors,

rd ed London: Baillere Tindal; 1994.p. 237–92.

Gilbert J, Kamath PA. Spontaneous bacterial peritonitis: In

update. Mayo Clin Proc 1995;70:365–70.

al-Amri SM, Allan AR, al-Mofleh IA. Spontaneous bacterial

peritonitis and culture negative neutrocytic ascites in patients

with no-alcoholic liver cirrhosis, J Gastroenterol Hepatol


Puri AS, Puri J, Ghoshel UC, Sharma BC, Sarawat VA,

Ayyagari A, et al. Frequency, microbial spectrum and

outcome of SBP in north India. Indian J Gastroenterol


Guarner C, Runyon BA, Young S, Heck M, Sheikh MY.

Intestinal bacterial overgrowth and bacterial translocation in

cirrhotic rats with ascites. J Hepatol 1997;26:1372–8.

Sheer TA, Runyon BA. Spontaneous bacterial peritonitis.

Dig Dis 2005;23(1):39–46.

Gaurner C, Soriano G. Spontaneous bacterial peritonitis.

Semin Liver Dis 1997;17(3):203–17.

Such J, Runyon BA. Spontaneous bacterial peritonitis. Clin

Infect Dis 1998;27:669–74.

Iqbal S, Iman N, Alam N, Rahman S. Incidence of

Spontaneous bacterial peritonitis in liver cirrhosis, the

causative organisms and antibiotic sensitivity. J Postgrad

Med Insi 2004;18:614–9.

Pinzello G, Simonetti RG, Craxì A, Di Piazza S, Spanò C,

Pagliaro L. Spontaneous bacterial peritonitis: a prospective

investigation in predominantly non alcoholic cirrhotic

patients. Hepatology 1983;3(4):545–9.

Imran M, Hashmi SN, Altaf A, Rashid H, Hussain T.

Spontaneous bacterial peritonitis. Professional Med J


Rajput MR, Zuberi BF, Shaikh WM, Solangi GA, Shaikh

SM, Shaikh GM. Frequency, microbial spectrum, clinical and

biochemical features of SBP and its variants. J Coll

Physicians Surg Pak 1999;9(8):347–50.

Mohammad T, Ali A, Noor-ul-iman, Yield of ascetic fluid

culture in SBP in Cirrhosis. J Med Sci 2010;18(1):59–62.

Haider I, Ahmad I, Rashid A, Bashir H, Causative Organisms

And their drug sensitivity pattern in Ascitic fluid of cirrhotic

patients with SBP, J Postgrad Med Inst 2008;22:333–9.