Spontaneous bacterial peritonitis: Management and identification of commonest bacterial species

Background: Spontaneous bacterial peritonitis is a serious problem in cirrhotic patients, and changes in the microbiological profile reported in the last years are impacting the choice of antibiotic used for treatment. Objective: The aim of this study was to investigate the causative bacteria and their susceptibility patterns to antimicrobial agents in patients with SBP in our locality in order to clarify the empirical antimicrobial treatment. Methods: 72 cirrhotic patients with primary and recurrent spontaneous bacterial peritonitis were included in the study, peritoneal aspirate was cultured on blood culture and isolates were identified by VITEK II. The most frequent infecting organisms and the sensitivity in vitro to antibiotics were registered. Results: The patients' age ranged from 50-65 years, 41 were males (56.9%) and 31 were females (43%). Staph epidermidis and micrococcus luteus were the most prominent Gram positive bacteria, whereas Escherichia coli (E.coli) were the most prominent Gram negative bacteria.100% of Gram negative bacteria were resistant to all tested antibiotics. Many strains among Gram positive isolated bacteria were multidrug resistant (MDR): Dermacoccus nishinomiyaensis with rate of 11.1% (3/27), Enterococcus faecalis 7.4% (2/27), Enterococcus faecium 14.8% (4/27), Micrococcus luteus 22.2% (6/27), Staph epidermidis 22.2%(6/27) and Staph lentus 11.1% (3/27). Kocuriarosea were extreme drug resistant(XDR) with a ratio of 11.1% (3/27). Conclusion: Frequent detection of the organisms causing peritonitis is a must to avoid haphazard use of antibiotics for prophylaxis and treatment to decrease morbidity and mortality.