Cases Of Spontaneous Bacterial Peritonitis Research Articles

16S rRNA Next-Generation Sequencing May Not Be Useful for Examining Suspected Cases of Spontaneous Bacterial Peritonitis.

Background and Objectives: Ascites, often associated with liver cirrhosis, poses diagnostic challenges, particularly in detecting bacterial infections. Traditional methods have limitations, prompting the exploration of advanced techniques such as 16S rDNA next-generation sequencing (NGS) for improved diagnostics in such low-biomass fluids. The aim of this study was to investigate whether the NGS method enhances detection sensitivity compared to a conventional ascites culture. Additionally, we aimed to explore the presence of a microbiome in the abdominal cavity and determine whether it has a sterile condition. Materials and Methods: Ten patients with clinically suspected spontaneous bacterial peritonitis (SBP) were included in this study. A traditional ascites culture was performed, and all ascites samples were subjected to 16S ribosomal RNA gene amplification and sequencing. 16S rRNA gene sequencing results were interpreted by comparing them to positive and negative controls for each sample. Results: Differential centrifugation was applied to all ascites samples, resulting in very small or no bacterial pellets being harvested. The examination of the 16S amplicon sequencing libraries indicated that the target amplicon products were either minimally visible or exhibited lower intensity than their corresponding negative controls. Contaminants present in the reagents were also identified in the ascites samples. Sequence analysis of the 16S rRNA gene of all samples showed microbial compositions that were akin to those found in the negative controls, without any bacteria isolated that were unique to the samples. Conclusions: The peritoneal cavity and ascites exhibit low bacterial biomass even in the presence of SBP, resulting in a very low positivity rate in 16S rRNA gene sequencing. Hence, the 16S RNA sequencing method does little to enhance the rate of positive samples compared to traditional culture methods, including in SBP cases.

Ascitic Fluid Calprotectin And Ratio Of Calprotectin To Total Protein In Spontaneous Bacterial Peritonitis.

To evaluate the diagnostic and prognostic role of ascitic fluid calprotectin and its ratio to total protein in spontaneous bacterial peritonitis cases. The prospective study was conducted at Kafrelsheikh University Hospital, Egypt, from November 2019 to December 2020, and comprised cirrhotic patients of either gender with ascites. Diagnostic abdominal paracentesis was performed for all patients and ascetic fluid calprotectin was measured. Patients were followed for development of spontaneous bacterial peritonitis or mortality. Data was analysed using SPSS 20. Of the 90 patients, 61(67.7%) were males and 29(32.2%) were females. There were 67(74.4%) patients with spontaneous bacterial peritonitis; 48(71.6%) males and 19(28.3%) females with mean age 60.42±8.3 years. The remaining 23(25.5%) did not have spontaneous bacterial peritonitis; 13(56.5%) males and 10(43.4%) females with mean age 59.7±7.4 years. The patients had significantly higher calprotectin, and calprotectin/total protein ratio (p<0.05). Logistic regression identified ascitic fluid calprotectin as a significant predictor of mortality (p=0.05). The non-survivors had significantly higher ascitic fluid calprotectin and calprotectin/total protein ratio compared to the survivors (p<0.05). Ascites calprotectin level and itsratio to total protein wasfound to be accurate diagnostic and predictive biomarkers for spontaneous bacterial peritonitis.

S3393 Assessing the Epidemiology and Microbiology of Spontaneous Bacterial Peritonitis at a Canadian Institution. a Retrospective Analysis

Introduction: Spontaneous bacterial peritonitis (SBP) is an infection of ascitic fluid that commonly occurs in patients with liver cirrhosis. Antibiotic prophylaxis is recommended for patients who are at high risk of developing SBP or to prevent a recurrent infection in patients previously diagnosed with SBP. However, much concern has risen regarding the changing landscape of the microbiology of SBP, antibiotic resistance patterns and the initiation and length of treatment. The microbiological characteristics of SBP are changing worldwide. The objectives of this study are to evaluate the changes to the epidemiology of the bacteria causing SBP in the West Coast of Canada and the appropriateness of the current treatment regimen with regards to local resistance patterns. Methods: The study conducted was a single center, retrospective chart review of patients diagnosed with spontaneous bacterial peritonitis at our center in Vancouver, Canada. Cases were identified retrospectively over a 10-year period ranging from Jan 1st, 2010 to Jan 31st, 2020. Clinical and laboratory and microbiological data were collected and calculated within 3 days of the diagnosis of SBP. Patient outcomes of infection were tracked. Results: From January 1st, 2010 to January 31st, 2020, 56 cases of spontaneous bacterial peritonitis were identified. Mean age was 59. 70% of patients were male, 30% were female. Ascitic fluid cultures were positive in 31 cases (56%) and negative in 25 cases (45%). The prevalence of microorganisms in ascitic fluid cultures in descending order were E. faecalis (16%), E. coli (12%), S. aureus (10%) and K. pneumoniae (4%). The prevalence of antibiotic resistance to vancomycin was 7.14%. Resistance rates for ceftriaxone and quinolones was 3.57% and for both pip-tazo and oxacillin was 1.79%. There was no resistance identified with TMP-SMX. Our study found a significant difference in length of hospital stay in patients with antibiotic resistance versus those without. Conclusion: Our study reveals that there are not any concerning rates of resistance seen with current antibiotic treatment of spontaneous bacterial peritonitis at our center. However, they provide insight into the regional epidemiological and microbiological trends of infection pertaining to our center and a basis for the ongoing monitoring of the effectiveness of antibiotic treatments for spontaneous bacterial peritonitis.

A Prospective Study of Etiological Agents Among Febrile Patients in Sierra Leone.

IntroductionSierra Leone has one of the highest burdens of febrile illnesses in the world. As the incidence of malaria diminishes, a better understanding of the spectrum of etiological agents was important for accurate diagnosis and empirical treatment of febrile illness.MethodsBlood, nasopharyngeal, and fecal specimens were collected from febrile patients for serological, molecular detection, and microbiologic culture to identify potential pathogens.ResultsFor this prospective study, 142 febrile patients were enrolled. The prevalence of malaria was higher in children aged 5–15 years old (P = 0.185) and adults (P = 0.018). Acute respiratory infection (ARI) presented more commonly in the under 5 years old group (P = 0.009). For diarrhea, all children groups (P = 0.024) were predominant. A total of 22.5% of the febrile patients had malaria infection, 19.7% had typhoid infection, and 2.8% were coinfected with malaria and typhoid. ARI was the most common causes of fever, accounting for 31.7% of patients, influenza A virus, Mycoplasma pneumoniae, and five other respiratory pathogens were found. Diarrhea accounted for 16.2%, and seven kinds of diarrhea bacteria were isolated. Hepatitis B accounted for 8.5%, including five cases of spontaneous bacterial peritonitis, and ascites smear staining were both Gram-negative bacteria. Tuberculous encephalitis, parasitic diseases (ascaris and filariasis), and skin infection caused by Staphylococcus aureus accounted for 0.7%, 2.1%, and 0.7%, respectively.ConclusionsEvidence of a wide spectrum of febrile etiological agents other than malaria was identified. The spread of malaria rapid diagnostic tests (RDTs) out of hospital and establishment of a national standard for Widal test will reduce the misdiagnosis of febrile diseases. Antibiotics against Gram-negative bacteria are helpful for empirical treatment.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40121-021-00474-y.

A retrospective analysis of cases of Spontaneous Bacterial Peritonitis in cirrhosis patients.

Spontaneous Bacterial Peritonitis (SBP) is an infection in patients with cirrhosis and carries significant mortality. The management of SBP is evolving with the rise of multidrug resistant organisms. Our aim was to perform a retrospective analysis to determine if identification of bacteria in culture could aid in prognosis and provide information regarding optimal treatment. We analyzed our 10-year experience of SBP in a single academic center (Northwestern Memorial Hospital). We obtained information regarding SBP prophylaxis, culture data and resistance patterns of bacteria, choice/duration of inpatient antibiotics, and key laboratory measurements and determined outcomes including mortality, hospital duration, and ICU stay. Patients with SBP had a 17.8% mortality and had culture positive SBP 34.4% of the time. Antimicrobial resistance was seen in 21.3% of cases and trended towards worsening mortality, with worsened mortality associated with first line use of piperacillin-tazobactam (p = 0.0001). Patients on SBP prophylaxis who developed SBP had improved mortality (p<0.0001) unless there was a positive culture, in which case patients had worsened mortality (p = 0.019). Patient with a higher PMN counts after repeat paracentesis had higher mortality (p = 0.02). Our results show that SBP continues to be a morbid and deadly condition and identification of an organism is key in treatment. The standard initial antibiotic for SBP may need to be modified to reflect emerging resistant pathogens and gram-positive organisms. Further, antibiotic prophylaxis should be utilized only in select cases to prevent development of resistance.

Prevalence of cryptococcal antigenemia in hospitalized patients with liver cirrhosis.

The benefits of screening for cryptococcal antigenemia and of preemptive antifungal treatment in HIV-infected patients have been proven. Liver cirrhosis is an important risk factor for cryptococcal infections. Cryptococcal infections are rapidly fatal in patients with liver cirrhosis, especially when diagnosis is delayed. However, screening for cryptococcal antigenemia has not been investigated in these patients. The aim of this study was to investigate the prevalence of cryptococcal antigenemia in hospitalized patients with liver cirrhosis. This prospective study was conducted at Seoul National University Hospital from July 2017 to January 2018. We included patients with liver cirrhosis who were admitted regardless of symptoms or signs suggesting cryptococcal infections. The severity of cirrhosis was evaluated from Child-Pugh and model for end-stage liver disease (MELD) scores. Serum cryptococcal antigenemia was determined using a latex agglutination test. A total of 294 patients were included in the analysis, comprising 104 (35.4%), 100 (34.0%), and 90 (30.6%) patients in Child-Pugh classes A, B, and C, respectively. There were 21 cases of spontaneous bacterial peritonitis, and 14 of hepatic encephalopathy, but none of cryptococcal peritonitis or meningitis. In addition, none of the patient specimens tested positive in the serum cryptococcal latex agglutination test (one-sided 97.5% confidence interval, 0% ∼ 1.2%). Liver cirrhosis is a major risk factor for cryptococcal infections, but the prevalence of serum cryptococcal antigen positivity in patients with liver cirrhosis is very low. Therefore, screening for cryptococcal antigenemia and preemptive antifungal treatment in cirrhotic patients might not be beneficial.

Evaluation of Granulocyte Elastase Enzyme in Diagnosis of Spontaneous Bacterial Peritonitis

Background and study aim: The most common infections in decompensated liver cirrhotic ascites patients are cases of spontaneous bacterial peritonitis (SBP), which account for 40%–70% of cases. SBP is a bacterial infection that occurs in absence of an evident intra-abdominal or surgically treatable source of infection. Patients and methods: This study was conducted on 80 patients with liver cirrhosis and ascites; 40 patients of them without SBP (group A) and 40 patients of them with SBP (group B) who were admitted to the Hepatology, Gastroenterology and Infectious Diseases Department, Benha University Hospital in the period between April 2014 and October 2014. Full history taking, clinical examination and laboratory investigation were done. Ascitic fluid analysis was done including detection of granulocyte elastase level. Results: Granulocyte elastase was markedly elevated in group B; mean ascitic fluid GE ELISA (4.1±2.8) comparing with group A (0.8±0.7) and it revealed a high statistically significant association between SBP and GE (P value <0.05). SBP was more common in child C. Fever, hypotension and abdominal pain were more common in SBP group. Conclusion: Granulocyte elastase is increased in cases of SBP, cutoff value of ascitic fluid (GE) for diagnosis of SBP at 0.88 ng/mL had 100% sensitivity, 75% specificity, 80% positive predictive value, 100% negative predictive value and 87.5% accuracy.

Enteroccocus pallens as a potential novel human pathogen: three cases of spontaneous bacterial peritonitis

Introduction:Enterococcus pallens is one of the four yellow-pigmented members of the genus Enterococcus. To date, a single report of E. pallens isolated from a human sample has been published.Case presentation:We report three cases of E. pallens spontaneous bacterial peritonitis in patients with liver cirrhosis that all occurred in Quebec, Canada. Ascitic fluid analysis revealed the presence of E. pallens in culture. Identification was made by classical biochemical testing and MALDI-TOF MS, as well as 16S rRNA and elongation factor (tuf) gene sequencing. Two of the three patients recovered after antimicrobial treatment.Conclusion:This report identifies E. pallens as a novel human pathogen that appears to possess particular but as-yet unidentified virulence factors that favour the development of peritoneal fluid infections, as previously reported for other Enterococcus species. Clinical microbiologist should be aware of this micro-organism which can be identified by phenotypic and molecular methods.

A study of bacteriological profile of ascitic fluid in suspected clinical cases of spontaneous bacterial peritonitis at a tertiary care hospital in India

Background: Spontaneous bacterial peritonitis (SBP) is the development of a monomicrobial infection of ascitic fluid in the absence of any contiguous source of infection. It occurs most commonly in conjunction with cirrhosis of the liver and alcoholic liver diseases. Majority of the SBP cases are caused by gram-negative organisms, mostly Escherichia coli. Objective: To isolate the various bacteriological agents from ascitic fluid from clinically suspected cases of SBP and to determine their antibiotic sensitivity pattern. Materials and Methods: In this study, 217 ascitic fluid samples from clinically suspected cases of SBP were collected from December 2011 to November 2012. Ascitic fluid was collected by bedside tapping in blood culture bottle aseptically and immediately sent to a microbiology laboratory, Sir T Hospital, Bhavnagar, Gujarat, for microbiological examination. Bacterial examination and antibiotic sensitivity tests were carried out by standard microbiological techniques. Results: Of 217 clinically suspected cases of SBP, 71 (43.80%) had ascitic fluid polymorphonuclear cells (PMN) count ≥ 250/mm3. Among 71 cases, 31 (43.6%) cases were culture positive and 40 (56.4%) cases were culture-negative neutrocytic ascites. From 31 culture-positive cases, E. coli was isolated from 17 (54.9%) cases; Klebsiella spp. was isolated from 5 (16.2%) cases; Staphylococcus aureus was isolated from 6 (19.3%) cases; and Pseudomonas aeruginosa was isolated from 3 (9.6%) cases. All isolates were sensitive to cefotaxime and ceftriaxone. Conclusion: If diagnosed early, SBP can be treated with high success rate, thus ascitic fluid laboratory analysis including culture of all suspected patients will help in improving prognosis of the patients.

간세포암종 환자에서 간동맥화학색전술 치료 직후 발생한 자발성 세균성 복막염 2예

간세포암종 환자에서 간동맥화학색전술 치료 직후 발생한 자발성 세균성 복막염 2예

Investigation into bacteremia and spontaneous bacterial peritonitis in patients with liver cirrhosis in Japan

Liver cirrhosis patients tend to develop bacteremia, but relatively little has been reported about the situation in Japan. Therefore, we investigated the microorganisms involved and the outcome among liver cirrhosis patients with bacteremia, including spontaneous bacterial peritonitis. The subjects were 236 patients who underwent a total of 377 blood cultures and 30 patients diagnosed with spontaneous bacterial peritonitis, among 6,096 inpatients with liver cirrhosis admitted to several hospitals during the period 1991-2009. The rate of positive blood culture was 37.1% (140/377), and the isolated microorganisms were predominantly Gram-negative bacteria. In patients with confirmed bacteremia, the Child-Pugh score and serum blood urea nitrogen and creatinine levels were significantly higher than in non-bacteremia cases. Moreover, short-term mortality (within 1 month) was 48.2% (53/110), being significantly higher than that among non-bacteremia cases (18.8%; 22/117). Among spontaneous bacterial peritonitis cases, mortality within one month was 33.3% (10/30). Again, the Child-Pugh score and serum blood urea nitrogen and creatinine levels were significantly higher among the fatalities than among survivors. These results indicate that severity of liver dysfunction and severity of renal dysfunction are both important determinants of short-term mortality among liver cirrhosis patients with bacteremia and spontaneous bacterial peritonitis in Japan.

Bacterial DNA in the diagnosis of spontaneous bacterial peritonitis

Despite inoculation into blood culture bottles, ascitic fluid culture is negative in 50% of cases of spontaneous bacterial peritonitis (SBP). To determine whether 16S rDNA gene detection by real-time polymerase chain reaction (PCR) and sequencing increases the efficacy of culture in microbiological diagnosis of spontaneous bacterial peritonitis. We prospectively included 55 consecutive spontaneous bacterial peritonitis episodes in cirrhotic patients, 20 cirrhotic patients with sterile ascites and 27 patients with neoplasic ascites. Ascitic fluid was inoculated into blood culture bottles at the bedside and tested for bacterial DNA by real-time PCR and sequencing of 16S rDNA gene. Bacterial DNA was detected in 23/25 (92%) culture-positive SBP, 16/30 (53%) culture-negative SBP (P = 0.002 with respect to culture-positive SBP), 12/20 (60%) sterile ascites (P = 0.01 with respect to culture-positive SBP) and 0/27 neoplasic ascites (P < 0.001 with respect to other groups). Sequencing identified to genus or species level 12 culture-positive SBP, six culture-negative SBP and six sterile ascites. In the remaining cases with positive PCR, sequencing did not yield a definitive bacterial identification. Bacterial DNA was not detected in almost half the culture-negative spontaneous bacterial peritonitis episodes. Methodology used in the present study did not always allow identification of amplified bacterial DNA.

Identification of bacterial DNA in neutrocytic and non‐neutrocytic cirrhotic ascites by means of a multiplex polymerase chain reaction

Even though bacterial cultures of ascitic fluid are negative in up to 65% of the cases of spontaneous bacterial peritonitis (SBP); bacterial DNA (bactDNA) has been frequently detected in episodes of SBP as well as in culture-negative non-neutrocytic ascites. To evaluate multiplex polymerase chain reaction (PCR) for pathogen identification in SBP and to determine the prevalence of ascitic bactDNA and its prognostic relevance in hospitalized patients with liver cirrhosis. Ascitic fluid from 68 consecutive patients who underwent diagnostic paracentesis was analysed for polymorphonuclear leucocyte (PMN) count, bacterial culture and bactDNA. BactDNA was identified by gel analysis after multiplex PCR of selectively enriched prokaryotic nucleic acids. Correlations of bactDNA status with PMN count, bacterial culture result and 3-month mortality were determined for neutrocytic and for non-neutrocytic ascites. 11/68 patients presented with an elevated ascitic PMN count. BactDNA was detected in 5/5 culture-positive neutrocytic samples, in 1/6 culture-negative neutrocytic samples and in 8/56 culture-negative non-neutrocytic samples. Three-month mortality did not differ with respect to ascitic bactDNA status (7/14 vs. 14/47, P=0.162). 3-month mortality was increased in the presence of ascitic bactDNA for patients older than 65 years (4/5 vs. 4/14, P=0.046) and for patients with a model for end-stage liver disease score >15 (7/10 vs. 9/30, P=0.025). Identification of ascitic bactDNA is an appropriate alternative to bacterial ascite culture for pathogen identification in patients at risk for SBP. Its prognostic relevance as a proposed marker of bacterial translocation for certain risk groups has to be further evaluated.

Evaluation of reagent strips for ascitic fluid leukocyte determination: is it a possible alternative for spontaneous bacterial peritonitis rapid diagnosis?

In order to evaluate the accuracy of a urine reagent dipstick (Multistix 10SG) to determine ascitic fluid leukocyte count, we prospectively studied 106 cirrhotic patients from April 2003 to December 2004, in two different centers (Federal University of São Paulo - UNIFESP-EPM and Federal University of Juiz de Fora - HU-UFJF) for the rapid bedside diagnosis of spontaneous bacterial peritonitis. The mean age 54 +/- 12 years, there was a predominance of males (eighty-two patients, 77%), and alcohol was the most frequent etiology (43%). Forty-four percent of patients were classified as Child B and fifty-one as Child C (51%). Abdominal paracentesis was performed both in outpatient and inpatient settings and the Multistix 10SG was tested. Eleven cases of spontaneous bacterial peritonitis were identified by means of polymorphonuclear count. If we considered the positive Multistix 10SG result of 3 or more, the sensitivity, specificity, positive and negative predictive value were respectively 71%, 99%, 91% and 98%. With a positive reagent strip result taken as grade 2 (traces) or more, sensitivity was 86% and specificity was 96% with positive and negative predictive values of 60% and 99%, respectively. Diagnostic accuracy was 95%. We concluded that the use of a urine reagent dipstick (Multistix 10SG) could be considered a quick, easy and cheap method for ascitic fluid cellularity determination in SBP diagnosis.

Listeria monocytogenes peritonitis in cirrhotic patients: first description in Brazil

Two cases of spontaneous bacterial peritonitis (SBP) caused by Listeria monocytogenes in cirrhotic patients are reported. In one of the cases, the microorganism was isolated from pleural effusion and ascites. SBP is a serious and common complication of patients with ascites caused by hepatic cirrhosis and the culture of the ascitic fluid is an important tool for the diagnosis and for the more appropriate treatment. Although a third generation cephalosporin has usually been employed for empiric treatment of SBP, it does not provide adequate coverage against Listeria spp. In such cases the use of ampicillin (with or without sulbactam) or sulfamethoxazole-trimethoprim is recommended. The last one is used for secondary prophylaxis, instead of norfloxacin. To summarize, Listeria monocytogenes infection is a rare cause of SBP, whose treatment should be specific for the bacteria.

Infected and Noninfected Ascites in Pediatric Patients

To determine the prevalence of spontaneous bacterial peritonitis, ascites with bacterial infection and noninfected ascites in pediatric patients with portal hypertensive ascites and to compare the clinical and laboratory features of infected and noninfected ascites. Forty-one episodes of portal hypertensive ascites (serum-ascites albumin gradient >1.1 g/dL) in 31 patients were studied. Median age was 2.9 years. Twenty-four (77.4%) patients were cirrhotic and 20 (83.3%) were classified as Child-Pugh C. Median pediatric end-stage liver disease score was 18.5. The following ascites features were assessed: polymorphonuclear neutrophil cell count, cytology, pH, concentration of glucose, lactic dehydrogenase, total protein and albumin, Gram stain and bacteriological culture. Blood was sampled for complete blood count, coagulation studies, liver and renal function tests. Groups were compared by Mann-Whitney and chi tests (P < 0.05). Noninfected ascites were observed in 29 of 41 samples, spontaneous bacterial peritonitis in eight of 41 and ascites with bacterial infection in four of 41. The most prevalent clinical features were fever, voluminous ascites and encephalopathy, but there were no significant differences in the clinical features of the groups. All patients with infected ascites were cirrhotic. There was no statistical difference in Child-Pugh or pediatric end-stage liver disease status between patients with infected and noninfected ascites. Culture of ascetic fluid was positive in four of eight cases of spontaneous bacterial peritonitis. Gram-negative rods were the most prevalent bacteria cultured. Except for serum albumin, no statistical differences in biochemical markers were observed between patients with infected and noninfected ascites. The prevalence of infected ascites was 29.2%. With the exception of serum albumin, there were no differences in the clinical and biochemical features of patients with infected ascites and noninfected ascites.

Causative organisms and changes of their antibiotic resistance during the recent 5 years in 641 cases of spontaneous bacterial peritonitis (SBP) in Korea

Causative organisms and changes of their antibiotic resistance during the recent 5 years in 641 cases of spontaneous bacterial peritonitis (SBP) in Korea

Causative organisms and changes of their antibiotic resistance during the recent 5 years in 641 cases of spontaneous bacterial peritonitis (SBP) in Korea

Causative organisms and changes of their antibiotic resistance during the recent 5 years in 641 cases of spontaneous bacterial peritonitis (SBP) in Korea

Early microbiologic diagnosis of spontaneous bacterial peritonitis with BacT/ALERT

Background/Aims: Inoculation of ascitic fluid into conventional blood culture bottles is more sensitive than conventional culture in the diagnosis of spontaneous bacterial peritonitis. BacT/ALERT is an automated colorimetric microbial detection system that has been shown to be faster than conventional blood culture bottles in the diagnosis of bacteremia. The aim of the study was to compare the BacT/ALERT system with the conventional culture and the conventional blood culture bottles method in the diagnosis of spontaneous bacterial peritonitis. Methods: All the ascitic fluid samples from patients with cirrhosis hospitalized in our Department between September 1992 and May 1994 ( n = 1032) were prospectively evaluated. In all cases, an aliquot of ascitic fluid was sent for Gram's stain and conventional culture, and 20 ml were inoculated at the bedside into blood culture bottles: 10 ml into conventional blood culture bottles and 10 ml into BacT/ALERT. Results: Thirty ascitic fluid infections (23 spontaneous bacterial peritonitis and 7 neutrocytic ascites) and 20 bacterascites were diagnosed. Conventional culture was positive in 10 30 ascitic fluid infections (33.3%), conventional blood culture bottles in 22 30 (73.3%) ( p<0.01 compared to conventional culture) and BacT/ALERT in 20 30 (66.6%) ( p<0.05 compared to conventional culture, pNS compared to conventional blood culture bottles). The time elapsed for culture positivity was 43.4±34.2 h for conventional blood culture bottles and 13.3±9.2 h for BacT/ALERT ( p<0.001). Thirteen of the 23 cases of spontaneous bacterial peritonitis (56.5%) were detected within the first 12 h with BacT/ALERT, as compared to only three (13%) with conventional blood culture bottles ( p<0.03). Conclusion: The automated system BacT/ALERT provides an earlier microbiologic diagnosis of spontaneous bacterial peritonitis than conventional blood culture bottles with similar sensitivity.

Spontaneous bacterial peritonitis: Analysis of treatment and outcome.

Spontaneous bacterial peritonitis occurred on 44 separate occasions in 43 patients during a five year period, including 27 culture positive and 17 probable cases of spontaneous bacterial peritonitis. Alcoholic liver disease was the underlying cause of 72% of cases. Of the 27 culture positive cases, Escherichia coli was the most common isolate (14 cases), followed by Klebsiella pneumoniae (three cases), group G streptococci (three cases), group B streptococci (two cases) and one case each of five other organisms. Bacteremia occurred in 50% of cases and was the same as the peritoneal isolate 88% of the time. The overall mortality rate was 65% (66% culture positive and 60% probable spontaneous bacterial peritonitis). The mean interval between onset of symptoms and death was 10.2±8.6 days in fatal cases. Spontaneous bacterial peritonitis was felt to be a contributing cause of mortality in 70% of fatal cases. Survivors were younger (44±20 years versus 59±13, P<0.05) and less likely to develop renal insufficiency than nonsurvivors (38% versus 73%, P<0.05). Patients who were treated with an aminoglycoside were more likely to develop renal failure compared to those treated with nonaminoglycoside regimens (P<0.05). There was no difference in mortality rate between culture positive and culture negative spontaneous bacterial peritonitis, total peritoneal leukocyte counts, Gram-positive versus Gram-negative organisms, presence of bacteremia, or serum albumin or bilirubin levels. The mortality rate for this disease remains unacceptably high, indicating a need for the development of new strategies in the prevention, diagnosis and management of this disease.