Prevalence, microbiological profile, and outcomes of spontaneous bacterial and fungal peritonitis in Egyptian patients with liver cirrhosis

BACKGROUND: One of serious side effects of liver cirrhosis is spontaneous bacterial peritonitis (SBP), which is defined by existence of infected ascites without a discernible secondary source of infection. One possible mechanism for development of SBP is microbial translocation. OBJECTIVE: To ascertain prevalence, microbiological profile and outcomes of spontaneous bacterial and fungal peritonitis in Egyptian patients with liver cirrhosis. METHODS: Three hundred cirrhotic patients with ascites who were hospitalized for spontaneous peritonitis (SP) participated in cross-sectional research. Laboratory investigations using bacterial and fungal cultures were carried out. RESULTS: All participants with diagnosis of SP were included. Their mean age was 59.50 years, and 68.7% of them were men. In addition, 13.7% of subjects had spontaneous fungal peritonitis, whereas 47.3% of participants had SBP. Of SBP cases, 50.7% (n = 72) had gram negative (-ve) bacteria isolated from them, whereas 49.3% (n = 70) had gram positive (+ ve) bacteria. Streptococcus 8.5% (n = 12) was the commenest gram-positive isolate, followed by Staphylococcus aureus 33.8%(n = 48). On the other hand, Klebsiella 29.6% (n = 42) was the commenest gram-negative isolate, followed by Escherichia coli 14.4%(n = 19). The outcome of SBP cases with and without multidrug resistance do not differ significantly. On multivariate analysis, femal (p = 0.013), low ascitic protein level and high ascitic lactate dehydrogenase (LDH) (p = 0.018, p = 0.014) were significant independent predictors for SFP. CONCLUSION: SBP and SFP frequently provide serious life-threatening dangers in cirrhotic patients with ascites. Alertness for SFP is increased with low ascitic protein level and high ascitic LDH.