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Progression to spontaneous bacterial peritonitis in decompensated cirrhotic patients with non-neutrocytic bacterascities: Results from a third world country

Muhammad Kamran, Hafiz Abdul Basit Siddiqui, Rabeea Azmat, Najib ullah Khan, Abdul Wahab

Objective: To determine the frequency of progression to spontaneous bacterial peritonitis in cirrhotic patients with non-neutrocytic bacterascites.

Methodology: This was a descriptive cross-sectional study. A non-probability consecutive sampling technique was used, and sample size of 127 was calculated using WHO calculator, with a margin of error of 0.07 (7%), and a level of significance of 0.05 with a 95% confidence interval. Our study comprised of 127 inpatients aged between 18-75 years, who were admitted between August 2015 to February 2016, in the gastroenterology ward of the Aga Khan University Hospital, Karachi. Those who fulfilled the inclusion criterion were included in the study.

Results: Among 127 patients, 63 (49.6%) were diagnosed to have spontaneous bacterial peritonitis (SBP) or its variants. Among them, classical spontaneous bacterial peritonitis was present in 18 (28.57%) patients, 34 (53.96%) patients were found to have culture negative neutrocytic ascites, and 11 patients (17.46%) were reported to have non-neutrocytic bacterascites. Our data showed that among 63 (49.6%) cases of spontaneous bacterial peritonitis, 29 (46.03%) of the samples of ascitic fluid had positive culture reports. E. coli was identified as the most frequently isolated organism that was cultured among 17 (58.62%) out of the 29 cases of SBP; Staphylococcus aureus was confirmed among 4 (13.79%) case; Streptococcus pneumoniae was noted among 3 (10.34%) patients; our data demonstrated that there were 3 (10.34%) cases of Proteus and Klebsiella was confirmed among 2 (6.89%) cases. Out of 11 patients who initially had non-neutrocytic bacterascites, E. coli was the most frequently isolated organism 6 (54.54%), followed by Klebsiella which was seen in 2 18.18%) patients, Staphylococcus aureus was noted in 2 (18.18%) cases, and there was 1 case of Proteus (9.09%).

Conclusion: The results of this study show that the frequency of progression from non-neutrocytic bacterascites to classical SBP is higher than previously reported among Pakistani population. Consequently, patients who have non-neutrocytic bacterascites need to be closely followed and a repeat diagnostic paracentesis should be performed in all such patients, so that progression to classical SBP is detected early and treated accordingly, hence preventing mortality.