Citation Information :
Gupta V, Chhina RS, Chaudhary J, Aggarwal M, Chawla P, Kaur D. Etiology and Antimicrobial Susceptibility Profile of Isolates from Ascitic Fluid of Patients with Spontaneous Bacterial Peritonitis. J Gastrointest Infect 2014; 4 (1):47-50.
Background & Objectives: Ascitic fluid infections are frequent complications among patients of cirrhosis with ascities, of which spontaneous bacterial peritonitis (SBP) is the most common and potentially fatal. This study was planned to know the etiology and current antibiotic susceptibility profile of the isolates from the SBPpatients.
Material and Methods: A total of 50 cases of SBP from cirrhosis patients with ascites were enrolled in this study. Samples were processed in automated Bactec or Bac-T /Alert. Further identification & antimicrobial susceptibility testing was done by VITEK-2 system.
Results: Most common organism isolated was Escherichia coli (40%) followed by Coagulase negative Staphylococci, Klebsiella pneumonia and Acinetobacter baumanii. Among all Gram negative isolates, 94.7% were sensitive to tigecycline, 92.1% sensitive to colistin. It also showed high susceptibility to amikacin and carbapenems while low susceptibility was seen to others. All the gram positive organisms were sensitive to vancomycin & linezolid and show moderate sensitivity to ciprofloxacin, tetracycline, cotrimoxazole, and gentamycin. Low sensitivity was seen to penicillin. Methicillin resistant coagulase negative Staphylococci (MRCoNS) were seen in 4 (57%) isolates.
Interpretation & Conclusion: Escherichia coli is the most common cause of SBP. Antimicrobial resistance is increasing therefore early detection and determination of antimicrobial susceptibility pattern is important to reduce the mortality and morbidity associated with ascitic fluid infections.
Bacon BR. Cirrhosis and its complications. In: Longo DL, Fauci AS, Karper DL, Hausen SL, Jameson JL, Loscalzo J editors. Harrison's principles of Internal medicine. 18th ed McGraw Hill New York; 2012. p.2592-3.
Runyon BA. Ascites and spontaneous bacterial peritonitis. In: Feldman M, Friedman LS, Brandt LJ editors. Sleisenger, Fordtran's Gastrointestinal and liver disease Pathophysiology/ Diagnosis/Management. 9th ed Saunders Elsevier Philadelphia; 2012.p.1517-25.
European association of the study of the liver. EASL clinical practical guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. Journal of Hepatology. 2010;53(3):397-417.
Tsao GG. Current management of the complications of cirrhosis and portal hypertension: variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Gastroenterology. 2001;120 (3):726-48.
Winn JW, Washington W, Allen S, Janda W, Koneman E, Procop G et al. Introduction to Microbiology: Part II: Guidelines for the collection, transport, processing, analysis and reporting of cultures from specific specimen sources. In: Koneman's color atlas and textbook of diagnostic microbiology. 6th ed. Philadelphia: Lippincot Willams and Willikins; 2006.p.103-5.
Nadagouda SB, Mahesh B, S.V. Kashinakunti, M S Birader. Spontaneous bacterial peritonitis in cirrhosis of liver with ascites-a cross sectional study. Int J Biol med Res. 2013;4(2): 3143-7.
Syed VA, Ansari Ja, Karki P, Regmi M, Khanal B. Spontaneous Bacterial Peritonitis in cirrhotic ascites: Aprospective study in a tertiary care hospital, Nepal. Kathmandu Univ Med J. 2007;5:48-59.
Khan Z, Khan I, Ud Din J, Subhan F, Khan B, Khan H. Frequency of spontaneous bacterial peritonitis in cirrhotic patients with ascites due to hepatitis C virus and efficacy of ciprofloxacin in its treatment. Gomal J Med Sci. 2009;7(2):149- 54.
Kamani L, Mumtaz K, Ahmed US, Ali AW, Jafri W. Outcomes in culture positive and culture negative ascitic fluid infections in patients with viral cirrhosis: cohort study. BMC Gastroenterology. 2008;8:59.
Reginato TJ, Oliveira MJ, Moreira LC, Lamanna A, Acencio MM, Antonangelo L. Characteristics of ascitic fluid from patients with suspected spontaneous bacterial peritonitis in emergency units at a tertiary hospital. Sao Paulo Med J. 2011;129(5):315-9.
Abd Elaal MM, Zaghloul SG, Bakr HG, Ashour MA, Abdel- Aziz-El-Hady H, Khalifa NA, Amr GE. Evaluation of different therapeutic approaches for spontaneous bacterial peritonitis. Arab J Gastroenterol. 2012;13:65-70.
S Bankar, ADe, S Baveja. Study of ascitic fluid for diagnosis of spontaneous bacterial peritonitis (SBP) in adult patients with cirrhosis. IJMAS. 2014;3(1): 1-9.
El-Bendary MM, Abdel-Aiz M, EL-Sherbiny Walid A, Farag R, El-Gilany AH, Zaghloul Mohd HE. Spontaneous Bacterial Peritonitis: Clinico-epidemiological and microbiological study. Benha Med J. 2009;26:287-9.
Park MK, Lee JH, Byun YH, Lee Hle, Gwak GY, Choi MS, et al. Changes in the profiles of causative agents and antibiotic resistance rate for spontaneous bacterial peritonitis: an analysis of cultured micro-organisms in recent 12 years. Korean J Hepatol. 2007;13(3):370-7.
Sheikhbahaei S, Abdollahi A, Hafezi-Nejad N, Zare E. Patterns of antimicrobial resistance in the causative organisms of spontaneous bacterial peritonitis: A single centre, six-year experience of 1981 samples. International Journal of Heptology. 2014;2014:917856.
Puri AS, Puri J, Ghoshal UC, Sharma BC, Saraswat VA, Ayyagari A et al. Frequency, microbial spectrum & outcome of Spontaneous Bacterial Peritonitis. Indian J Gastroenterol. 1996; 15(3):86- 9. J Gastrointest