Introduction Spontaneous bacterial peritonitis (SBP) is a sinister complication of cirrhosis associated with poor survival (approximately 38% at 1 year1). However, a diagnosis of SBP does not represent, in its own right, an indication for liver transplantation in the UK under current listing criteria.
Methods We sought to investigate the prevalence and subsequent mortality in patients with an admission diagnosis of SBP. We retrospectively identified 366 consecutive cases admitted with ascites to our liver unit during the calendar year 2009. Of these 271 (74%) patients underwent diagnostic paracentesis at time of admission and were included for further analysis.
Results Of the 271 cases, 26 (9.6%) were diagnosed with SBP at admission on the basis of an ascitic fluid white cell count above 250 cells/mm3 (25 cases). Patients with positive cultures but no white cell response were only included if symptomatic (one case). Alcohol was the underlying aetiology in 17 cases (65.4%) and clinical presentations were as follows: routine paracentesis (14 cases), associated pleural effusion (four cases), variceal haemorrhage (three cases), abdominal pain (two cases), jaundice (two cases), encephalopathy (one case). Ascitic culture on two patients grew gram-negative bacilli, both resistant to quinolones being used for prophylaxis. One ascitic culture grew Lactobacillus spp. and one a mixed growth of Enterococcus faecalis and gram-positive cocci. Three patients (11.5%) died during the index admission. Three patients (11.5%) had successfully undergone liver transplantation and were alive 6 months after admission. Overall mortality at 6 months from an admission diagnosis of SBP was 50%.
Conclusion SBP is not uncommon in cirrhotic patients with ascites, can often present silently and is associated with high mortality. Resistance to standard quinolone prophylaxis and isolation of gram-positive bacteria are more recent phenomena in this group of patients. All cirrhotics admitted with significant ascites should undergo diagnostic paracentesis to exclude SBP and assessment for liver transplantation must be an urgent consideration in appropriate candidates. Listing criteria may need to be revised to include SBP as a standard indication.
Competing interests None declared.
Reference 1. Tito L, et al. Recurrence of spontaneous bacterial peritonitis in cirrhosis: frequency and predictive factors. Hepatology 1988;8:27–31.
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