Identification of Ascitic Fluid Bacterial Pathogens in Spontaneous Bacterial Peritonitis in Nile Delta and Its Impact on Clinical Outcome of these Patients

Aims: This study aimed to identify ascetic fluid bacterial pathogens and their antibiotic resistance profile in Spontaneous Bacterial Peritonitis (SBP) patients in Nile delta and its impact on the clinical outcome of these patients.

Study Design: Retrospective observational study.

Place and Duration of Study: Patients enrolled in this study were admitted to Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Egypt. Further laboratory work was carried out at Microbiology and Immunology Department, Faculty of Medicine, Tanta University, Egypt, from July 2015 to June 2016.

Methodology: 247 patients with liver cirrhosis and ascites who met the clinical criteria for suspicion of SBP including: fever, encephalopathy, refractory ascites and abdominal pain were enrolled in the study. Patients were subjected to thorough history and clinical examination. Ascetic fluid sampling was done for every patient and ascetic fluid analysis was done including cell counts and differential counts. Also, ascitic fluid culture, microbiological testing and antimicrobial sensitivity tests were done.

Results: Out of 247 patients enrolled in this study with liver cirrhosis, ascites and clinical suspicion of SBP, 138 patients were excluded. These excluded patients included: 91 patients had ascetic fluid neutrophils below 250 cells/mm3, 4 patients were cases of secondary peritonitis with polymicrobial culture and 43 patients were found to started empirical antibiotics within 5 days of admission. Out of 109 patients who had SBP, 28 only were culture positive. Among culture positive SBP, 16 (57.1%) were Gram positive and 12 (42.9%) were Gram negative. The most common organism isolated was Gram positive Enterococci followed by E. coli and Staph aureus.

Conclusion: While Gram negative bacteria were the main infectious agents causing SBP a few decades ago, and are still reported to be so in the most recent recommendations and reviews, Gram positive bacteria are now predominant and there is a rising prevalence of bacteria with reduced susceptibility to cephalosporins and fluoroquinolones as regarding this study only and not including previous data or speculations. Current international guidelines recommend the use of a third-generation cephalosporin for empirical treatment of SBP which raise the questions about these guidelines and if they are still valid.