Microbial Spectrum and Antibiotic Sensitivity Patterns in Ascitic Fluid of Cirrhotic patients with Spontaneous Bacterial Peritonitis

Background: Spontaneous bacterial peritonitis is an acute infection of otherwise sterile ascitic fluid in patients with decompensated liver cirrhosis. Gram negative bacteria are considered the main causative microorganisms of SBP. However, widespread use of antibiotics in cirrhotic patients has changed the microbial spectrum and the sensitivity patterns. Aim: To determine the frequency of different microorganisms and their sensitivity patterns in ascitic fluid of cirrhotic patients with spontaneous bacterial peritonitis and to see the impact of age, gender and duration of SBP on these patterns. Study design and duration: It was a prospective observational study conducted at Medical Unit III of Sir Ganga Ram Hospital, Lahore from December 2017 to December 2018. Methods: A total of 260 patients with clinical suspicion of SBP were enrolled in the study. Ascitic fluid sample was obtained within 6 hours of hospitalization and was sent to hospital laboratory. Culture reports were reviewed to determine the frequency of different microorganism as well as their sensitivity patterns to different antibiotics. Results: Out of 260 patients, the culture was positive in 157(56.53%) patients. Escherichia coli was seen in 49(31.2%) patients, Acinobacter Spp was present in 24(15.3%), Streptococcus in 21(13.4%), Enterococcus in 19(12.1%), Staphylococcus aureus in 18(11.4%), MRSA in 17(10.8%), and K. Pneumonia in 9 (5.7%) patients. Ceftazidime was sensitive in 102 (64.9%) cases, Cefotaxime was sensitive in 77 (49%), Ceftriaxone was sensitive in 69(43.9%), Ciprofloxacin was sensitive in 68(43.3%), Amikacin was sensitive in 50 (31.8%), Co Amoxiclave was sensitive in 40(25.5%) and Imipenum was sensitive in 26 (16.6%) cases. Conclusion: The most frequent organism in ascitic fluid of SBP patients was E Coli, and the most sensitive antibiotic was ceftazidime.