Clinical significance of anaerobic microbiology in ascites of chronic liver disease

Background: Hundreds of anaerobes are part of the normal flora of the skin, mouth, and gastrointestinal tract. Disruption can lead to severe infections. Anaerobes are rarely reported in peritoneal fluid due to cultivation challenges. Spontaneous bacterial peritonitis (SBP) is a major cause of morbidity and mortality in chronic liver disease (CLD). Objective: To determine the clinical significance of anaerobic bacteria in the ascitic fluid of CLD patients. Methods: A prospective study at a tertiary care institute included 200 CLD patients with ascites. Ascitic fluid samples were cultured for anaerobic bacteria using Robertson’s cooked meat media and identified with VITEK 2 system. Antimicrobial susceptibility was tested with E-Tests in ascitic fluid were included in the study. Results: Anaerobic bacteria were found in 7 of 200 samples (3.5%). Isolated bacteria included Clostridium subterminale, Clostridium difficile, Clostridium sordellii, Clostridium perfringens, Staphylococcus saccharolyticus, Clostridium group, and Actinomyces naeslundii. High resistance was noted for ciprofloxacin. Imipenem and vancomycin showed 85% sensitivity, while chloramphenicol, tetracycline, and linezolid showed 71% sensitivity. Conclusion: Anaerobic bacteria can cause SBP in CLD patients. Routine paracentesis should be emphasized for effective diagnosis and treatment. High antibiotic resistance rates call for careful use and monitoring of antibiotics.