Spontaneous bacterial peritonitis in decompensated cirrhotic patients with ascites

Abstract

Between February 1993 and March 1994 a prospective descriptive study was carried out in 25 cirrhotic patients (three of them on two occasions) with clinical or ultrasonographic ascites; they were hospitalized in the Internal Medicine ward of San Vicente de Paúl Hospital, in Medellín, Colombia, because of decompensation. All of them went through diagnostic paracentesis with cytologic, bacteriologic and chemical studies. Average age was 43.9 years (13 to 77 years), 13 were women (52%) and 12 men (48%). Infection of the ascitic fluid was found in 11 cases (39.3%), namely: Bacterascites 6 cases (monomicrobial 3 cases (27.3%), polymicrobial 3 cases (27.3%», spontaneous bacterial peritonitis 3 cases (polymicrobial 2 cases (18.2%) and monomicrobial1 case (9.1 %») and neutrocytic ascites 2 cases (18.2%). Seventy two percent of the infectious episodes caused fever (p < 0.01) and in 46% there was abdominal pain (p < 0.1). AII patients with infected ascites belonged to Child's classification C. Serum albumin levellower than 2 g/dl was a risk factor for developing infection. Escherichia coli was cultivated on 5 occasions (45.5%), viridans group of Streptococci in 5 (45.5%), anaerobes in 3 (27.3%) and other bacteria in 3 (27.3%). Mortality due to infected ascites was 27.3% (3 cases), comparable to that produced by other causes that was 29.4% (5/17). We conclude that ascitic fluid infection is a common complication in decompensated cirrhotic patients. Thecardinal clinical signs are fever and abdominal pain. The frequent isolation of E. coli and viridans group Streptococci has to be taken into account for the initiation of antibiotic therapy in cases with clinical suspicion.