Rising resistance: The shifting microbial landscape of spontaneous bacterial peritonitis in cirrhosis

Background: Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication in cirrhotic patients with ascites. It involves infection of the ascitic fluid without a clear intra-abdominal source, leading to significant morbidity and mortality. Aims and Objectives: This study aims to evaluate the clinical presentation, microbiological profile, and antibiotic sensitivity patterns in patients diagnosed with SBP at a tertiary care center. Materials and Methods: A cross-sectional study was conducted among 208 inpatients diagnosed with SBP at a tertiary care hospital in Bengaluru. Detailed clinical data, culture results, and antibiotic resistance profiles were analyzed using descriptive and inferential statistics (Statistical Package for Social Sciences version 20.0). Results: Of the 208 patients, 98.6% were male, with a mean age of 48.3 years. Alcohol-related cirrhosis accounted for 99% of cases. The most common clinical features included abdominal distension (100%), pedal edema (94.2%), and jaundice (75%). Escherichia coli was the most prevalent isolate (65.5%). Highest antibiotic sensitivity was observed for piperacillin/tazobactam (32.1%) and ciprofloxacin (25%). Alarmingly, all isolates exhibited resistance to third-generation cephalosporins. Conclusion: SBP continues to be a significant complication in decompensated cirrhosis. Empirical treatment should align with local antimicrobial resistance patterns. The observed resistance to cephalosporins underscores the urgent need to revise treatment guidelines and implement robust antimicrobial stewardship.