Prevalence And Microbial Spectrum Of Patients With Spontaneous Bacterial Peritonitis In Northeast Nigeria – A Cross-Sectional Multi-Centre Study

Background: Spontaneous bacterial peritonitis (SBP) is the most common infectious complication of cirrhosis, requiring prompt recognition and treatment. It is a recognized cause of death. Normal ascitic fluid is sterile, spontaneous presence of bacteria in this fluid is detrimental and needs to be investigated. This study aimed to determine the prevalence of primary ascitic fluid infection, the microbial agents involved, and their antibiotic sensitivity pattern among patients with cirrhosis and ascites seen at our facilities. Methodology: A cross-sectional multi-centre study among patients diagnosed with liver cirrhosis and ascites who presented at four major tertiary institutions in Northeastern Nigeria from January 2024 to December 2024. All eligible participants underwent abdominal paracentesis under aseptic conditions and were subjected to microscopy, culture, and sensitivity using the BACT Alert 3D automated method. The data were analysed using SPSS version 26 (IBM SPSS Inc., Chicago, Illinois, USA). Results: A total of 150 cirrhotic patients were studied, among whom 97 (64.7%) were males, with a male-female ratio of 1.8:1. The age of the patients ranged from 22 to 86 years, with a mean of 53.9 ± 13.4 years. The prevalence of primary ascitic fluid infection was 64%. All the positive culture samples were monomicrobial, and the most commonly isolated organisms were Escherichia coli (43.8%), Staphylococcus aureus (26.0%), and Klebsiella spp. (13.5%). The most sensitive antibiotics were levofloxacin (92 -100%), gentamicin (76.9 – 100%), imipenem (76.9 – 100%), piperacillin-Tazobactam (75.0 – 100%), and ciprofloxacin (69.0 – 100%). Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, Streptococcus spp., and Enterobacter spp. were found to be 100% resistant to cotrimoxazole. More specifically, Enterobacter spp. was found to be multidrug-resistant (MDR). Conclusion: The prevalence of primary ascitic fluid infection among the cirrhotic patients was high. It is therefore recommended that prophylactic antibiotics be given to any patient with ascites and cirrhosis to prevent fatal complications of SBP.