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. 2024 Dec 31;16(12):e76679.
doi: 10.7759/cureus.76679. eCollection 2024 Dec.

Spontaneous Bacterial Peritonitis: Etiology, Microbiology, and Clinical Outcomes in Cirrhosis Patients

Lal Krishna U  1 , Deni J  1 , Ramu M  1 , Sandesh K  1 , Saji K Sebastian  2 , Gaurav Khatana  2 , Gino R Philip  2
Affiliations

Spontaneous Bacterial Peritonitis: Etiology, Microbiology, and Clinical Outcomes in Cirrhosis Patients

Lal Krishna U et al. Cureus. .

Abstract

Objective: Spontaneous bacterial peritonitis (SBP) is a critical complication in patients with liver cirrhosis, often resulting in high mortality. Understanding the microbiological agents causing SBP and their antibiotic resistance patterns is essential for effective treatment, particularly in tertiary care settings. This prospective observational study aimed to identify the microbial profile of SBP, evaluate antibiotic sensitivity, and assess patient outcomes.

Methodology: The study included 100 patients over 18 years old with chronic liver disease and SBP. Data collected included demographics, ascitic fluid analysis, cultures, liver and renal function tests, ultrasonograms, and disease etiology. Scoring systems such as sequential organ failure assessment (SOFA), child-turcotte-pugh (CTP), and model for end-stage liver disease (MELD) were calculated. Patients received standard care, and outcomes (discharge or mortality) were recorded.

Results: Of the 100 patients with SBP, 91% were men. Most were classified as child-turcotte-pugh Class C (66%), with the remainder as Class B (34%). The leading cause of cirrhosis was alcohol use (72%), followed by metabolic-associated steatotic liver disease (MASLD), hepatitis B virus (HBV), and hepatitis C virus (HCV). Prior antibiotic exposure was noted in 21% of cases. Despite prophylaxis, SBP developed in 19%. Ascitic fluid cultures showed no growth in 56%, but Escherichia coli (16%) and Klebsiella species (8%) were the most common pathogens isolated. Acute-on-chronic liver failure (ACLF) occurred in 19%, with a mortality rate of 89%. Multidrug-resistant (MDR) and extensively drug-resistant (XDR) pathogens were identified in 5% and 3% of cases, respectively.

Conclusion: This study identifies Escherichia coli as the most prevalent pathogen in SBP and highlights the impact of comorbidities like diabetes and dyslipidemia on outcomes. High sequential organ failure assessment scores, hepatic encephalopathy, variceal bleeding, renal failure, mechanical ventilation, and alcoholic liver disease significantly increased mortality risk. The emergence of multi-drug-resistant and extensively drug-resistant pathogens underscores the need for vigilant monitoring, early intervention, and customized antibiotic therapies to manage SBP effectively in cirrhotic patients.

Keywords: antibiotic sensitivity; ascites; drug resistance; liver disease; spontaneous bacterial peritonitis.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Government Medical College Kottayam, Kerala issued approval IRB/04/2023. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

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