Frequency of Culture-Negative and Culture-Positive Ascites in Chronic Liver Disease Patients Presenting with Spontaneous Bacterial Peritonitis

Muhammad Rizwan Subhani; Adnan Salim; Amna Fareed; Rashid Murad; Umair Shahid; Ammar Arshad

doi:10.70749/ijbr.v3i4.861

Authors

Muhammad Rizwan Subhani Department of Gastroenterology, Shaikh Zayed Hospital, Lahore, Pakistan.
Adnan Salim Department of Gastroenterology, Shaikh Zayed Hospital, Lahore, Pakistan.
Amna Fareed Department of Gastroenterology, Shaikh Zayed Hospital, Lahore, Pakistan.
Rashid Murad Department of Gastroenterology, Shaikh Zayed Hospital, Lahore, Pakistan.
Umair Shahid Department of Gastroenterology, Shaikh Zayed Hospital, Lahore, Pakistan.
Ammar Arshad Department of Gastroenterology, Shaikh Zayed Hospital, Lahore, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i4.861

Keywords:

Spontaneous Bacterial Peritonitis, Chronic Liver Disease, Ascitic Fluid, Culture-Negative Ascites

Abstract

Background: Spontaneous bacterial peritonitis (SBP) is a severe complication in chronic liver disease (CLD) patients, characterized by infection of ascitic fluid. The differentiation between culture-positive and culture-negative ascites plays a significant role in understanding the pathology of SBP and ensuring accurate diagnosis and treatment. This study investigates the prevalence of culture-negative and culture-positive ascites in CLD patients with SBP and evaluates the impact of demographic factors on ascitic fluid culture outcomes. Objective: To determine the frequency of culture-negative and culture-positive ascites in chronic liver disease patients presenting with spontaneous bacterial peritonitis to a tertiary care hospital. Study Design: Cross-sectional study. Duration and Place of Study: The study was conducted from November 2024 to February 2025 at the Department of Gastroenterology, PGMI/Shaikh Zayed Hospital, Lahore. Methodology: A total of 176 patients aged 30–60 years, diagnosed with CLD and presenting with suspected SBP, were enrolled using a non-probability consecutive sampling method. Ascitic fluid was collected within 24 hours of hospitalization for bacterial culture. Results: The mean age of patients was 46.17 ± 8.66 years, with a predominance of males (78.4%). Out of 176 samples, 50 (28.4%) were culture-positive and 126 (71.6%) were culture-negative. Gender significantly influenced culture positivity (p = 0.024), with a higher proportion of males showing positive results (32.6%) compared to females (13.2%). Conclusion: Our study concludes that spontaneous bacterial peritonitis with culture-negative ascitic fluid is common in cirrhotic patients. Duration of illness and gender significantly influence culture positivity. These factors should guide early intervention, while ongoing monitoring of microbial resistance and gender-sensitive treatment remain crucial for effective SBP management.

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References

Huang CH, Lee CH, Chang C. Spontaneous bacterial peritonitis in decompensated liver cirrhosis—a literature review. Livers. 2022; 2(3):214-32. https://doi.org/10.3390/livers2030018.

Canahuati Escobar JE, Hasan D, Dennis RL, Faris M. Clostridium perfringens as a rare cause of spontaneous bacterial peritonitis. Cureus. 2024 Sep;16(9):e68363. https://doi.org/10.7759/cureus.68363.

Yin X, Qin E, Song R, Bao X, Dong J, Hou W, Hua W, Tu B, Zhang Y, Meng Q. Diagnostic model for spontaneous bacterial peritonitis in cirrhotic patients with ascites: a multicenter cohort study. Eur J Gastroenterol Hepatol. 2024 Nov;36(11):1319-28. https://doi.org/10.1097/MEG.0000000000002841.

Manzo M, Desai P. Spontaneous bacterial peritonitis in a patient with nonportal hypertensive ascites. Ochsner J. 2022 Spring;22(1):100-3. https://doi.org/10.31486/toj.21.0050.

Ndomba N, Soldera J. Management of sepsis in a cirrhotic patient admitted to the intensive care unit: a systematic literature review. World J Hepatol. 2023 Jun;15(6):850-66. https://doi.org/10.4254/wjh.v15.i6.850.

De Siervi S, Cannito S, Turato C. Chronic liver disease: latest research in pathogenesis, detection and treatment. Int J Mol Sci. 2023 Jun;24(13):10633. https://doi.org/10.3390/ijms241310633.

Fouad Y, Alboraie M, Shiha G. Epidemiology and diagnosis of metabolic dysfunction-associated fatty liver disease. Hepatol Int. 2024 Oct;18(Suppl 2):827-33. https://doi.org/10.1007/s12072-024-10704-3.

Aithal GP, Palaniyappan N, China L, Härmälä S, Macken L, Ryan JM, et al. Guidelines on the management of ascites in cirrhosis. Gut. 2021 Jan;70(1):9-29. https://doi.org/10.1136/gutjnl-2020-321790.

Samonakis DN, Gatselis N, Bellou A, Sifaki-Pistolla D, Mela M, Demetriou G, et al. Spontaneous bacterial peritonitis: a prospective Greek multicenter study of its epidemiology, microbiology, and outcomes. Ann Gastroenterol. 2022 Jan-Feb;35(1):80-7. https://doi.org/10.20524/aog.2021.0674.

Engelmann C, Clària J, Szabo G, Bosch J, Bernardi M. Pathophysiology of decompensated cirrhosis: portal hypertension, circulatory dysfunction, inflammation, metabolism and mitochondrial dysfunction. J Hepatol. 2021 Jul;75(Suppl 1):S49-66. https://doi.org/10.1016/j.jhep.2021.01.002.

Du L, Wei N, Maiwall R, Song Y. Differential diagnosis of ascites: etiologies, ascitic fluid analysis, diagnostic algorithm. Clin Chem Lab Med. 2024;62(7):1266-76. https://doi.org/10.1515/cclm-2023-1112.

Lotte R, Courdurié A, Gaudart A, Emery A, Chevalier A, Tran A, et al. Spontaneous bacterial peritonitis: the incremental value of a fast and direct bacterial identification from ascitic fluids inoculated in blood culture bottles by MALDI-TOF MS for a better management of patients. Microorganisms. 2022 Jun;10(6):1188. https://doi.org/10.3390/microorganisms10061188.

Ormachea KX, Gregor L, Quintero J, George B, Singh S. Culture-negative neutrocytic ascites in a patient with cardiac ascites from end-stage heart failure. Cureus. 2024 Mar;16(3):e55802. https://doi.org/10.7759/cureus.55802.

Malli E, Gatselis NK, Dalekos GN, Petinaki E. Combination of vial culture and broad-range PCR for the diagnosis of spontaneous bacterial peritonitis: experience in a Greek tertiary care hospital. New Microbes New Infect. 2018 Dec;28:1-5. https://doi.org/10.1016/j.nmni.2018.12.001.

Sundaram V, Manne V, Al-Osaimi AM. Ascites and spontaneous bacterial peritonitis: recommendations from two United States centers. Saudi J Gastroenterol. 2014 Sep-Oct;20(5):279-87. https://doi.org/10.4103/1319-3767.141686.

Premkumar M, Anand AC. Overview of complications in cirrhosis. J Clin Exp Hepatol. 2022 Jul-Aug;12(4):1150-74. https://doi.org/10.1016/j.jceh.2022.04.021.

Falleti E, Cmet S, Cussigh AR, Salvador E, Bitetto D, Fornasiere E, et al. Recurrent and treatment-unresponsive spontaneous bacterial peritonitis worsens survival in decompensated liver cirrhosis. J Clin Exp Hepatol. 2021 May-Jun;11(3):334-42. https://doi.org/10.1016/j.jceh.2020.08.010.

Reginato TJ, Oliveira MJ, Moreira LC, Lamanna A, Acencio MM, Antonangelo L. Characteristics of ascitic fluid from patients with suspected spontaneous bacterial peritonitis in emergency units at a tertiary hospital. Sao Paulo Med J. 2011;129(5):315-9. https://doi.org/10.1590/s1516-31802011000500006

Ahmad I, Irfan H. Spontaneous bacterial peritonitis in cirrhotic patients: frequency and clinical presentations. Esculapio. 2024;19(4):500-3.

Zaman A, Kareem R, Mahmood R, Hameed K, Khan EM. Frequency of microbial spectrum of spontaneous bacterial peritonitis in established cirrhosis liver. J Ayub Med Coll Abbottabad. 2011;23(4):15-7.

Ayub M, Hussain S, Ahmed S, Iqbal MA. Prevalence of culture negative ascitic fluid infection among patients with chronic liver disease. Professional Med J. 2020;27(5):999-1003. https://doi.org/10.29309/TPMJ/2020.27.05.4074.

Bibi S, Ahmed WD, Arif A, Khan F, Alam SE. Clinical, laboratory and bacterial profile of spontaneous bacterial peritonitis in chronic liver disease patients. J Coll Physicians Surg Pak. 2015;25(2):95-9.

Mahato T, Sharma Y, Thapa S. Spontaneous bacterial peritonitis among chronic liver disease patients with ascites admitted to the department of medicine of a tertiary care centre: a descriptive cross-sectional study. J Nepal Med Assoc. 2023;61(260):300-4. https://doi.org/10.31729/jnma.8124.