Yield of ascitic fluid cultures in spontaneous bacterial peritonitis in cirrhosis

Objectives: to see the bacterial yield of ascitic fluid cultures in spontaneous bacterial peritonitis in cirrhosis liver patients with ascites and to know about the most common organism causing spontaneous bacterial peritonitis. material and methods: this study was conducted in the department of medicine khyber teaching hospital,peshawar between july 2000 and june 2001. fifty patients with cirrhosis liver having ascites and suspected spontaneous bacterial peritonitis (sbp) were included in this study. apart from the baseline tests,diagnostic paracentesis was performed in all patient at admission before starting antibiotics. ascitic fluid (10 ml) was inoculated in culture bottles followed by sub cultures,identification of bacteria and antibiotic sensitivity. results: out of 50 patients,20(40%) were hepatitis b surface antigen (hbs ag) positive,28(58%) were positive for anti hepatitis c antibodies and 2(4%) were positive for both. twenty-nine (58%) cases were found to have bacterial peritonitis. nineteen (65.51%) patients were anti hcv positive,8(27.58%) were hbs ag positive and 2(6.89%) were having both. patients were divided into three groups. eleven (37.93%) patients had classical sbp,16(55.17%) had culture negative neutrocytic ascites and 2(6.89%) had bacterascites. cultures were positive in 13(44.82%) patients. escherichia coli(61.55%) was the commonest organism isolated,streptococcus in 2(15.38%) cases and one(7.69%) each was staphylococcus,klebsiella and acinetobacter. conclusion: spontaneous bacterial peritonitis is a common complication of cirrhosis liver with ascites. it is easily overlooked and needs high clinical suspicion for diagnosis. ascitic fluid culture is the best method for diagnosis of sbp but is positive in less than half of cases.