title: Spontaneous ascitic fluid infection in liver cirrhosis: bacteriological profile and response to antibiotic therapy.
abstract: BACKGROUND
  Spontaneous ascitic fluid infection (SAI) is common in cirrhotic patients leading to significant morbidity and mortality. Third-generation cephalosporins are currently recommended as first-line therapy. We conducted a prospective study to determine bacterial etiology, susceptibility patterns, and clinical epidemiology including 1-month mortality of SAIs among patients with cirrhosis.
  
  
  METHODS
  Records of 600 patients with suspected SAI over a 4-year period were analyzed. Empirical cefotaxime/ceftriaxone was initiated in patients who had a neutrophil count >250/mm(3). Treatment failure was defined by absence of clinical improvement and/or significant decrease in neutrophil count of ascites (<25 % of base line value) by 72 h of therapy.
  
  
  RESULTS
  Seventy patients (11.6 %) had SAI, including 40 (57.1 %) culture-negative neutrocytic ascites (CNNA), 25 (35.8 %) spontaneous bacterial peritonitis (SBP), and five (7 %) monomicrobial non-neutrocytic bacterascites (MNB). Gram-negative bacilli (Klebsiella and E. coli) were the commonest organisms. The overall response rate to ceftriaxone was 62.8 % (44/70). Among culture-positive patients (SBP and MNB), sensitivity rates to ceftriaxone was 50 %, while it was 53.3 % for quinolones, 70 % for piperacillin-tazobactam, and 93.3 % for cefoperazone-sulbactam combination. Thirty-day mortality was lower for CNNA compared to SBP (20 % vs. 40 %, p < 0.001) and for patients with response compared to no response to first antibiotic (11.3 % vs. 53.8 %, p < 0.001).
  
  
  CONCLUSIONS
  The response of SAI to third-generation cephalosporins was low at our center. Cefoperazone-sulbactam could be a better alternative choice.
authors.affiliation: Department of Gastroenterology, Kasturba Medical College, Manipal University, Manipal 576 104, India. drbhatgs@rediffmail.com
authors.forename: Ganesh
authors.initials: G
authors.lastname: Bhat
authors.forename: K E
authors.initials: KE
authors.lastname: Vandana
authors.forename: Sumit
authors.initials: S
authors.lastname: Bhatia
authors.forename: Deepak
authors.initials: D
authors.lastname: Suvarna
authors.forename: Cannanore Ganesh
authors.initials: CG
authors.lastname: Pai
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001202:Ascitic Fluid / Q000382:microbiology*; D001424:Bacterial Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010538:Peritonitis / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents