Effect of Culture Technique on the Work Up in cirrhotic Patients with Spontaneous Bacterial Peritonitis

Document Type : Original Article

Authors

1 Department of Internal Medicine, Faculty of Medicine, Sohag University

2 Department of Internal medicine , Faculty of Midicine,Sohag University.

3 Department of Clinical and Chemical pathology, Faculty of Medicine, Sohag University

4 Department of Internal Medicine Faculty of Medicine, Sohag University

Abstract

Spontaneous bacterial peritonitis (SBP) is a serious complication in patients with advance liver cirrhosis and is associated with significant mortality. Multidrug resistance is an evolving problem in management of SBP. Therefore, early diagnosis and proper selection of antimicrobial therapy are warranted.                                             
Objective: Assessment of the accuracy of conventional culture compared to blood culture in diagnosis of SBP and evaluation the role of blood culture in selection of antimicrobial therapy for treatment of SBP.                            
Methods: One hundred unselected consecutive cirrhotic patients with moderate or severe ascitis who were admitted to Internal Medicine Department during the period from October 2016 to April 2017 were included. Diagnostic aspiration of the ascetic fluid was made for each patient. The aspirated samples underwent chemical and cytological analysis as well as inoculation on conventional culture and on blood culture. Positive growths were tested for antibiotic sensitivity.                                                                                               
Results: 47 patients (47%) among the 100 cirrhotic patients had spontaneous bacterial peritonitis. Positive growths were detected in 11 patients (23.4%) and in 32(68.1%) patients by using conventional culture and blood culture respectively. By using blood culture as gold stander, the sensitivity, specificity, positive predictive value and negative predictive value of conventional culture were 34.38%, 100%, 100% and 41.67% respectively. All isolated growths were sensitive to meropenem. Resistance to cefotaxime was detected in 20 cases (62.5%). Other tested drugs showed variable degrees of sensitivity.                                                                                                                                                               
Conclusion: Conventional culture is of low sensitivity in diagnosis of SBP among cirrhotic patients and blood culture should be considered the gold standard for diagnosis of SBP. Multidrug resistance in SBP is common and antibiotic selection should be based on culture and sensitivity tests.

Keywords


 
 
1-                       Giannelli V, Di Gregorio V, Iebba V, et al. Microbiota and the gut-liver axis: bacterial translocation, inflammation and infection in cirrhosis. World journal of gastroenterology: WJG 2014; 20:
2-                       Nousbaum JB, Cadranel JF, Nahon P, et al. Diagnostic accuracy of the Multistix 8 SG reagent strip in diagnosis of spontaneous bacterial peritonitis. Hepatology 2007; 45: 1275-81.
3-                       Runyon  BA.  Management  of  adult  patients  with  ascites  due  to  cirrhosis:  an update. Hepatology.2009;49(6):2087–2107.
4-                       Rimola A, Salmerón JM, Clemente G, Rodrigo L, Obrador A, Miranda ML, et al. Two different dosages of cefotaxime in the treatment of spontaneous bacterial peritonitis in cirrhosis: results of a prospective, randomized, multicenter study. Hepatology 1995; 21: 674-9.
5-                       Biecker E. Diagnosis and therapy of ascites in liver cirrhosis. World journal of gastroenterology: WJG 2011; 17: 1237.
6-                       Ginés P, Angeli P, Lenz K, Møller S, Moore K, Moreau R. European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol 2010; 53.
7-      Giannelli V, Di Gregorio V, Iebba V, et al. Microbiota and the gut-liver axis: bacterial translo-cation, inflammation and infection in cirrhosis. World journal of gastroenterology: WJG 2014; 20: 16795.
8-      Hanouneh MA, Hanouneh IA, Hashash JG, et al. The role of rifaximin in the primary prophylaxis of spontaneous bacterial peritonitis in patients with liver cirrhosis.  Journal of  clinical gastroenterology 2012; 46: 709-15.
9-      Rogers GB, van der Gast CJ, Bruce KD, et al. Ascitic microbiota composition is correlated with clinical severity in cirrhosis with portal hypertension. PloS one 2013; 8: e74884.
10-  Runyon BA, Canawati HN, Akriviadis EA. Optimization of ascitic fluid culture technique. Gastroenterology 1988; 95:1351.
12-  Wong CL, Holroyd-Leduc J, Thorpe KE, Straus SE. Does this patient have bacterial peritonitis or portal hypertension? How do I perform a paracentesis and analyze the results? JAMA 2008; 299:1166.
13-  Such J, Runyon BA. Spontaneous bacterial peritonitis.Clin Infect Dis 1998; 27:669-74.
14-  Akriviadis EA, Runyon BA. Utility of an algorithm in differentiating spontaneous from secondary bacterial peritonitis. Gastroenterology 1990; 98:127.
15-  Felisart J, Rimola A, Arroyo V, et al. Cefotaxime is more effective than is ampicillin–tobramycin in cirrhotics with severe infections. Hepatology 1985; 5: 457–62
16-   Runyon BA, McHutchison JG, Antillon MR, et al. Short-course vs. long-course antibiotic treatment of spontaneous bacterial peritonitis: a randomized controlled trial of 100 patients. Gastroenterology 1991; 100:1737–42.
17-  Navasa M, Follo A, Llovet JM, et al. Randomized, comparative study of oral ofloxacin versus intravenous cefotaxime in spontaneous bacterial peritonitis. Gastroenterology 1996;111: 1011–7.
18-  Runyon BA, Akriviadis EA, Sattler FR, et al. Ascitic fluid and serum cefotaxime and desacetylCefotaxime levels in patients treated for bacterial peritonitis. Dig Dis Sci 1991; 36:1782.
19-  Jalan R, Fernandez J, Wiest R, et al. Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. Journal of hepatology 2014; 60: 1310-24.
20-  Fernández J, Gustot T. Management of bacterial infections in cirrhosis. Journal of hepatology 2012; 56: S1-S12.