Abstract:

Background: Spontaneous bacterial peritonitis (SBP) is the most common infection of ascetic fluid occurs in patients with cirrhotic as ascites. Although these patients are exposed to several risk factors for SBP, no study has been conducted to assess the magnitude of SBP in our settings.

Objectives: To determine the prevalence, patterns and predictors of spontaneous bacterial peritonitis in adult patients with portal hypertension and ascites admitted at Bugando Medical Centre.

Materials and Methods: A Cross-sectional analytical study was conducted involving 300 patients with portal hypertension and ascites between October 2012 and April 2013. Demographic and other clinical data were collected using standardized data collection tools. Ascetic fluid culture, the gold standard for SBP diagnosis was done, for culture positive results susceptibility testing of common antibiotics using a disc diffusion method was done. Ascitic fluid cell count and bedside dipstick test were also done. Positive Ascitic fluid culture, Ascitic PMNs≥250cells/µL and positive dipstick test were diagnostic for SBP.

Results: Of the 300 patients, the prevalence of spontaneous bacterial peritonitis was 11.6% (35), of these 12 (4.0%) had culture positive spontaneous bacteria peritonitis and 23 (7.6%) had culture negative spontaneous bacterial peritonitis (CNNA). The most common bacteria isolated in culture positive SBP were staphylococcus aureus 33.3% (4/12), Streptococcus spp 25% (3/12) and Escherichia coli 16.6% (2/12). Most organisms isolated were susceptible to Ampicillin, 100% (2/2) Escherichia coli, 50% (2/4) Staphylococcus aureus and 66.6% (2/3) of Streptococcus spp respectively. The most commonly used antibiotic in our settings Ceftriaxone was found to be resistant to 72.7% of isolated microorganisms. History of Alcohol consumption, low mean arterial blood pressure on admission, abdominal pain, fever, low Ascitic fluid total protein, high indirect bilirubin and low serum protein were found to be predictors of spontaneous bacterial peritonitis.

Conclusion and Recommendations: Spontaneous peritonitis is common among patients with portal hypertension and ascites admitted at Bugando Medical Centre. Staphylococcus aureus, streptococcus spp and Escherichia coli are the commonest cause of spontaneous bacterial peritonitis in this setting. Fever, abdominal pain, encephalopathy and jaundice are highly suggestive of SBP, and diagnostic paracentesis should be done immediately on admission to confirm the diagnosis preferably before starting empiric antibiotic therapy.