Abstract

MICROBIOLOGICAL PROFILE OF SPONTANEOUS BACTERIAL PERITONITIS IN PATIENTS WITH LIVER CIRRHOSIS, A CROSS SECTIONAL HOSPITAL BASED STUDY IN SOUTH – INDIA

Waseem Raja*, Rohey Jan, S. K. Mathai, B. Sabistian and Ashfaq

Abstract

Introduction: Spontaneous bacterial peritonitis (SBP) is one of the leading causes of morbidity and mortality in patients with cirrhosis. Spontaneous Bacterial Peritonitis is defined as the infection of ascitic fluid without any primary source of infection such as intra-abdominal pathology or perforation of intestine or viscus. Aims and Objectives: The aim of present study is to determine the microbial agents responsible for SBP and the pattern of antibiotic sensitivity. Material and Methods: This Cross sectional hospital based study, was conducted in a tertiary care referral centre over a period of one year from March 2016 – April 2017, after obtaining approval from institutional ethical committee and consent from the patients. 198 ascitis fluid samples from clinically suspected cases of SBP were included in the study. Gram staining & Ascitic fluid culture was done in all patients using Bactec method and antibiotic sensitivity was assessed by disk diffusion technique. Microbiologic profile and antibiotic sensitivity pattern was recorded in all patients. Results: Out of 198 clinically suspected cases of SBP, 76 (38.38 %) had ascitic fluid polymorphonuclear cells (PMN) count ≥ 250/mm3. Among 76 cases, 31 (40.7 %) cases were culture positive and 45 (59.2 %) cases were culture-negative neutrocytic ascites. From 31 culture-positive cases, E. coli was the most common isolated organism followed by Klebsiella Pneumoniae & Enterobacter. Isolated organisms were E Coli in 11 (35.4%), Klebsiella Pneumoniae 7 (22.5%), Enterobacter 5 (16.1%), Pseudomonas aeruginosa 3 (9.6%), Acinetobacter and Enterococus in 2 (6.4%) cases each. Staphylococcus aureus was isolated from 1 (3.2%) cases. Of the 31 cultures only 2 (6.4%) were due to ESBL producing organisms. One patient with E.coli and one with Pseudomonas infection were resistant to Cephalosporines, Quinolones and Piperacillin Tazobactum, but sensitive to Imipenem and Meropenem. One patient had infection with Methicillin resistant staphylococcus sensitive to vancomycin, teicoplanin and Linezolid. Conclusion: Gram negative enteric pathogens remain the major cause of SBP in Liver Cirrhosis. Third generation cephalosporins and quinolones are still effective in treating SBP.

Keywords: E coli, Spontaneous bacterial peritonitis, Ascitic fluid culture, Cirrhosis.