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A Journal on Internal Medicine
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,236
Minerva Medica 1999 October;90(10):369-76
Spontaneous bacterial peritonitis: prevalence and characteristics in 314 cirrhotic patients evaluated at hospital admission
Marelli A., Nardecchia L., De Gennaro F., Bodini P.
Background. The aim of this study was to evaluate the incidence and the characteristics of the infections of ascitic fluid in cirrhotic patients at the moment of hospital admission. Methods. A total of 314 patients consecutively submitted to ascitic fluid tap within 3 days of hospital admission were studied. Each patient was classified according to Child-Plugh classes. Neoplastic ascites were escluded. The ascitic fluid was analyzed for PMN count, protein and albumin content, coltural and cytological examinations. The patients with ascitic fluid PMN>250/ml were immediately treated with antibiotics. Results. Out of 314 patients 11% had SBP (94% in class C patients according to Child-Plugh classification), 17% CNNA and 3% MNNB. 15% of SBP patients were asymptomatic. Total protein content in ascitic fluid was significantly lower in SBP and MNNB compared to CNNA and sterile ascites. 56% of the isolated bacteria was Gram-negative, and the most frequently fuond were Streptococcus, Escheri-chia coli and Staphylococcus. 80% of the patients with ascites infection underwent third generation cephalosporin treatment. SBP mortality (29%) was significantly higher thanCNNA (9%), MNNB (10%) and sterile ascites (11%), also taking into account the subgroup without ascites infection and class C group (14%).Conclusions. In view of the high incidence (even in the absence of invasive procedures), of the possibility of symptom free patients and of the high mortality of SBP, it is advisable to carry out routine tap in all cirrhotics with ascites at hospital admission.