Spontaneous Bacterial Peritonitis in the Medical Intensive Care Unit of a University Hospital in Egypt: Frequency, Bacteriological Profile, Risk Factors and Outcomes

Abstract

Objective: To assess the frequency of spontaneous bacterial peritonitis (SBP) in the Medical intensive care unit (ICU) of Zagazig University Hospital, identify the causative organisms, their susceptibility to antimicrobials, and to determine risk factors and clinical outcomes. Methods: One hundred and eighty-nine ascitic patients suffered of liver cirrhosis were included in this prospective study. Medical history, physical examination, radiological reports and assessment of disease severity were done. Diagnostic paracentesis was performed. Ascitic fluid was subjected to chemical, hematological and bacteriological investigations. Isolated bacteria and their antibiotic susceptibility pattern were identified using standard methods. Results: Frequency of SBP in ascitic patients due to liver cirrhosis was 56.1%. Classic SBP was diagnosed in 47.2% of cases and the remaining 52.8% were found to be culture negative neutrocytic ascites (CNNA). Comparison of the mean ± standard deviation (SD) of clinical and demographic characteristics for SBP versus non SBP revealed significant association with hepatocellular carcinoma (HCC) and with beta blockers(BB). Comparison between mean ± SD of clinical, biochemical and microbiological characteristics for SBP variants revealed significant association with HCC, total leucocytic count and positive culture. Significant symptoms and signs were observed with fever, hypotension and abdominal pain. E-coli was the most frequently isolated bacteria (56%), followed by Klebsiella pneumoniae 24% and Staphylococcus aureus 20%. Gentamicin was the most effective antibiotic in-vitro against K. pneumonia and E. coli isolates, while all S.