Prevalence and risk factors for unsuspected spontaneous ascitic fluid infection in cirrhotics undergoing therapeutic paracentesis in an outpatient clinic

Abstract

Spontaneous bacterial peritonitis (SBP) has been typically described in hospitalized patients. There are little data on ascitic fluid infection in asymptomatic outpatients. The present study was aimed at determining the prevalence and risk factors for asymptomatic ascitic fluid infection among patients with liver cirrhosis attending an outpatient clinic. Between January 2008 and December 2009, consecutive patients with cirrhosis (n = 110) undergoing therapeutic paracentesis in an outpatient setting were studied. Patients with fever, abdominal pain, hepatic encephalopathy, recent gastrointestinal bleeding, impaired renal function, previous history of SBP and on antibiotic treatment were excluded. Baseline demographic details, and etiology and severity of liver disease were recorded. Ascitic fluid cell count, culture and biochemical tests were done using standard laboratory techniques. The causes of cirrhosis were alcohol (55.5%), hepatitis B (21.8%), hepatitis C (9.1%) and others (13.6%). A total of 278 paracenteses were done in them (average 2.5 [1.1] times per patient). Spontaneous ascitic fluid infection was found in 7 (2.5%) paracentesis, including spontaneous bacterial peritonitis in one (0.4%), monomicrobial nonneutrocytic bacterascites (MNB) in two (0.7%) and culture-negative neutrocytic ascites (CNNA) in four (1.4%). Escherichia coli, Klebsiella spp. and Staphylococcus aureus were grown. There was no difference between cirrhotic outpatients with and without infection in age, gender, alcohol consumption, etiology of cirrhosis, Child-Pugh score, serum albumin and ascitic fluid total protein. There was no death due to spontaneous ascitic fluid infection. Asymptomatic ascitic fluid infection was very infrequent in patients with cirrhosis attending an outpatient clinic and undergoing therapeutic paracentesis.