Article-Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrh

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April 2003 • Volume 37 • Number 4

Original Articles: Liver Failure and Liver Disease

Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites

Luke T.

W. Ray Kim

J. Poterucha

S. Kamath

The prevalence and natural history of spontaneous bacterial peritonitis in asymptomatic patients with ascites secondary to cirrhosis is unknown. From a prospectively recorded database, we reviewed the clinical and laboratory features of all outpatients with cirrhotic ascites undergoing paracentesis between July 1994 and December 2000. The prevalence of spontaneous bacterial peritonitis in the population of 427 cirrhotic outpatients as defined by neutrocytic ascites (absolute neutrophil count 250 cells/mm3) was 3.5%. Of the 15 patients with neutrocytic ascites, 6 were culture positive (1.4%) and 9 culture negative (2.1%). Eight other patients (1.9%) had bacterascites. The organisms cultured from ascitic fluid in these asymptomatic patients with culture positive neutrocytic ascites and bacterascites were predominantly gram positive. No patient developed hepatorenal syndrome, and 1-year survival of 67% was better than historical data from hospitalized patients with spontaneous bacterial peritonitis. Moreover, patients who did not receive antibiotics for neutrocytic ascites fared no worse than patients who did receive antibiotics. In conclusion, spontaneous bacterial peritonitis in outpatients with cirrhotic ascites is less frequent, occurs in patients with less advanced liver disease, and may have a better outcome than its counterpart in hospitalized patients. In addition, the organisms cultured from ascitic fluid in outpatients are predominantly gram positive. A reassessment of diagnostic criteria for spontaneous bacterial peritonitis in outpatients may be required. (HEPATOLOGY 2003;37:897-901.)

Abbreviations

SBP spontaneous bacterial peritonitis

CNNA culture-negative neutrocytic ascites

MELD Model for End-Stage Liver Disease

From the Advanced Liver Diseases Study Group, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.

Copyright © 2003 by the American Association for the Study of Liver Diseases.