Spontaneous Bacterial Peritonitis in the Medical Intensive Care Unit of a University Hospital in Egypt: Frequency, Bacteriological Profile, Risk Factors and Outcomes

Abstract

Objectives: This work was carried out to assess the frequency of spontaneous bacterial peritonitis (SBP) and its variants in the medical intensive care unit (ICU) of the Internal Medicine department, zagazig Faculty of Medicine, Egypt and to identify the causative organisms and their susceptibility to commonly used antimicrobials. Other objectives were to determine risk factors and clinical outcomes. Subjects and methods: One-hundred and eighty- nine patients having ascites due to liver cirrhosis were studied. Each patient was subjected to: history collection, physical examination, diagnostic paracentesis, radiological and laboratory investigations and assessment of disease severity. Organisms isolated were identified and their antibiotic susceptibility profiles were tested. MELD score was used for diseases assessment. Risk factors and clinical outcomes were concluded using statistical methods. Results: Frequency of SBP was 56.1%. Classic SBP accounted for 47.2% of cases, while the remaining 52.8% were culture negative neutrocytic ascites (CNNA). E-coli were the most frequently isolated bacteria. Piperacillin- tazobactam was the most effective antibiotic.  SBP cases were significantly associated with hepatocellular carcinoma and with use of beta blockers. Patients with SBP were more likely to present with fever and abdominal pain, whereas those with non- SBP were more likely to present with hypotension. Non- significant relationship was found between SBP and non-SBP cases regarding ICU stay. Meanwhile mortality was higher among SBP cases; age and MELD score were the independent risk factor.