title: Prevalence and risk factors for unsuspected spontaneous ascitic fluid infection in cirrhotics undergoing therapeutic paracentesis in an outpatient clinic.
abstract: BACKGROUND
  Spontaneous bacterial peritonitis (SBP) has been typically described in hospitalized patients. There are little data on ascitic fluid infection in asymptomatic outpatients. The present study was aimed at determining the prevalence and risk factors for asymptomatic ascitic fluid infection among patients with liver cirrhosis attending an outpatient clinic.
  
  
  METHODS
  Between January 2008 and December 2009, consecutive patients with cirrhosis (n = 110) undergoing therapeutic paracentesis in an outpatient setting were studied. Patients with fever, abdominal pain, hepatic encephalopathy, recent gastrointestinal bleeding, impaired renal function, previous history of SBP and on antibiotic treatment were excluded. Baseline demographic details, and etiology and severity of liver disease were recorded. Ascitic fluid cell count, culture and biochemical tests were done using standard laboratory techniques.
  
  
  RESULTS
  The causes of cirrhosis were alcohol (55.5%), hepatitis B (21.8%), hepatitis C (9.1%) and others (13.6%). A total of 278 paracenteses were done in them (average 2.5 [1.1] times per patient). Spontaneous ascitic fluid infection was found in 7 (2.5%) paracentesis, including spontaneous bacterial peritonitis in one (0.4%), monomicrobial nonneutrocytic bacterascites (MNB) in two (0.7%) and culture-negative neutrocytic ascites (CNNA) in four (1.4%). Escherichia coli, Klebsiella spp. and Staphylococcus aureus were grown. There was no difference between cirrhotic outpatients with and without infection in age, gender, alcohol consumption, etiology of cirrhosis, Child-Pugh score, serum albumin and ascitic fluid total protein. There was no death due to spontaneous ascitic fluid infection.
  
  
  CONCLUSIONS
  Asymptomatic ascitic fluid infection was very infrequent in patients with cirrhosis attending an outpatient clinic and undergoing therapeutic paracentesis.
authors.affiliation: Department of Gastroenterology, Stanley Medical College, Old Jail Road, Royapuram, Chennai, Tamil Nadu 600 001, India. dr.pazhani@gmail.com
authors.forename: Pazhanivel
authors.initials: P
authors.lastname: Mohan
authors.forename: Jayanthi
authors.initials: J
authors.lastname: Venkataraman
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001202:Ascitic Fluid / Q000382:microbiology*; D001424:Bacterial Infections / Q000188:drug therapy / Q000382:microbiology*; D002439:Cefotaxime / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000008:administration & dosage; D010045:Outpatients; D019152:Paracentesis; D010538:Peritonitis / Q000188:drug therapy / Q000382:microbiology*; D015995:Prevalence; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D015242:Ofloxacin; D002439:Cefotaxime