Characterising spontaneous bacterial peritonitis in liver cirrhosis and hepatocellular carcinoma in southwestern Nigeria.

OBJECTIVES

This study determined the profile of spontaneous bacterial peritonitis (SBP) and its variants in patients with decompensated liver cirrhosis and hepatocellular carcinoma (HCC).

DESIGN

A descriptive cross-sectional study.

SETTING

The study was conducted in a tertiary hospital.

PARTICIPANTS

Patients with decompensated liver cirrhosis and HCC above 18 years.

INTERVENTIONS: Ascitic fluid (AF) samples were taken for cell count and culture using a BACTEC culture bottle. Sensitivity patterns and ascitic fluid total protein and albumin levels were also assessed.

MAIN OUTCOME MEASURES: Clinical profile of SBP, organisms isolated from the ascitic fluid and sensitivity of isolated organisms to antibiotics.

RESULTS

One hundred and six (106) participants were recruited. Seventy (66%) had liver cirrhosis, and 36 (34%) had HCC. The mean age was 50.08±12.66 years. Eighty-nine (84%) were males and 17(16%) were females. The overall prevalence of SBP was 29.2% (n = 31). Classical SBP was 5(4.7%), CNNA 20(18.9%) and monobacterial ascites 6(5.7%). The Gram-positive isolates were Staphylococcus aureus 5(45.5%) - [2(18.2%) MRSA, 3(27.3%) MSSA] while the Gram-negative organisms were E. coli 3(27.3%), Acinectobacter 2(18.2%) and Bulkholderia cepacia 1 (9.1%). Gram-negative bacteria showed absolute resistance to cephalosporins but were all susceptible to meropenem. Gram-positive bacteria showed 100% susceptibility to linezolid, vancomycin and daptomycin. Gram-positive bacteria also showed low resistance to fluoroquinolones (20%). Multi-drug resistance pattern was reported for MRSA, Acinetobacter baumannii and Bulkholderia cepacia.

CONCLUSION

SBP is a common complication in patients with decompensated CLD. Guided antibiotic treatment should be encouraged, particularly in light of the emergence of multidrug resistance patterns.

FUNDING: None declared.