Frequency of Culture-Negative and Culture-Positive Ascites in Chronic Liver Disease Patients Presenting with Spontaneous Bacterial Peritonitis

Background: Spontaneous bacterial peritonitis (SBP) is a severe complication in chronic liver disease (CLD) patients, characterized by infection of ascitic fluid. The differentiation between culture-positive and culture-negative ascites plays a significant role in understanding the pathology of SBP and ensuring accurate diagnosis and treatment. This study investigates the prevalence of culture-negative and culture-positive ascites in CLD patients with SBP and evaluates the impact of demographic factors on ascitic fluid culture outcomes. Objective: To determine the frequency of culture-negative and culture-positive ascites in chronic liver disease patients presenting with spontaneous bacterial peritonitis to a tertiary care hospital. Study Design: Cross-sectional study. Duration and Place of Study: The study was conducted from November 2024 to February 2025 at the Department of Gastroenterology, PGMI/Shaikh Zayed Hospital, Lahore. Methodology: A total of 176 patients aged 30–60 years, diagnosed with CLD and presenting with suspected SBP, were enrolled using a non-probability consecutive sampling method. Ascitic fluid was collected within 24 hours of hospitalization for bacterial culture. Results: The mean age of patients was 46.17 ± 8.66 years, with a predominance of males (78.4%). Out of 176 samples, 50 (28.4%) were culture-positive and 126 (71.6%) were culture-negative. Gender significantly influenced culture positivity (p = 0.024), with a higher proportion of males showing positive results (32.6%) compared to females (13.2%). Conclusion: Our study concludes that spontaneous bacterial peritonitis with culture-negative ascitic fluid is common in cirrhotic patients. Duration of illness and gender significantly influence culture positivity. These factors should guide early intervention, while ongoing monitoring of microbial resistance and gender-sensitive treatment remain crucial for effective SBP management.