Bacterial Peritonitis among Chronic Liver Disease Patients - A Cross-sectional Study from Northeast India

Background: In the present era of increasing antimicrobial resistance in multiple infections, many studies have shown that even with spontaneous bacterial peritonitis (SBP), the bacteriological and resistance patterns have changed over the years with regional variations. This study was conducted to determine the bacteriological profile of peritonitis patients among the group of cirrhotic patients and their outcomes. Methodology: This was a one-year cross-sectional observational study in which cirrhotic patients with ascites were evaluated for SBP. Cytological analysis, biochemical tests (albumin, protein, glucose, lactate dehydrogenase), and culture and sensitivity on the ascitic fluid were carried out. Results: 120 cirrhotic patients with ascites were included in the study. Thirty-eight (31.99%) patients had SBP. Classical SBP was present in 13 patients (34.21%), bacterascites in 7 patients (18.42%) and culture-negative neutrocytic ascites (CNNA) in 18 patients (47.36%). Escherichia coli was the most common organism (50%, n=10), followed by Acinetobacter spp. (15%, n=3), Klebsiella pneumoniae, Enterobacter spp. and Enterococcus spp. (10%, n=2 each), and methicillin-sensitive Staphylococcus aureus (MSSA) (5%, n=1). The mortality among the SBP patients was higher than that among the non-SBP patients (42.10% vs. 15.85%, p=0.0013). Sepsis (with or without septic shock) and renal failure were the most common causes of mortality in these SBP patients. Conclusion: The present study showed that culture-positive SBP in cirrhotic patients was mainly attributed to gram-negative bacterial infections. The resistance among common bacterial isolates was high against third-generation cephalosporins and fluoroquinolones. Patients with multidrug-resistant infections had poor outcomes.