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Background and objective Spontaneous bacterial peritonitis (SBP) is a common bacterial infection with life-threatening sequelae in cirrhotic ascites. The purpose of this retrospective cohort study was to recognize the predictors of SBP to build up a noninvasive system to exclude or establish an episode of SBP. Patients and methods Of 1194 consecutive patients with cirrhotic ascites, only 966 patients were enrolled in this study. SBP was diagnosed once polymorphonuclear count was at least 250 cells/mm3 and/or there was a positive ascitic fluid culture result. Biochemical and clinical parameters were evaluated as predictors of SBP. A scoring system was established in the training group of 682 and validated in a second group of 284 participants. Results The incidence of SBP was 12.3 and 12% in the training and validation groups, respectively. Age of at least 55 years, mean platelet volume (MPV) of at least 8.5 fl, neutrophil-to-lymphocyte ratio (NLR) of at least 2.5, and C-reactive protein (CRP) of at least 40 mg/l were identified as independent predictors of SBP. A scoring system including these four variables (age, MPV, and NLR with 1 point each, whereas CRP with 2 points) achieves a specificity of 98.2% with a positive predictive value for the diagnosis of SBP of 88.1% (score≥4). At a threshold of 1 point, the negative predictive value is 97.5% with a sensitivity of 92.9%. SBP is not associated with a high Model for End-stage Liver Disease score (P=0.135). Conclusion The combination of age, MPV, NLR, and CRP in a simple scoring system, Mansoura simple scoring system, supports quick and accurate exclusion or diagnosis of SBP.

Multi-drug resistant (MDR) strains of Acinetobacter baumannii are responsible for an increasing number of opportunistic infections in hospitals. This study determined the prevalence of MDR A. baumannii isolates from intensive care units in a large tertiary-care hospital in Ismailia, Egypt, and the occurrence of different beta-lactamases in these isolates. Biotyping and antimicrobial susceptibility profile was done for isolated strains. Respiratory, urine, burn wound and blood specimens were collected from 350 patients admitted to different units; 10 strains (2.9%) of A. baumannii were isolated. All isolates showed resistance to more than 3 classes of antibiotics. Among the isolates, 6 isolates were carbapenemase producers, 2 were AmpC beta-lactamase producers and no isolates were metallo-betalactamase producers. Despite the low prevalence of A. baumannii infection in this hospital, the antibiotic resistance profile suggests that prevention of health-care-associated transmission of MDR Acinetobacter spp. infection is essential. Parmi ces isolats, six produisaient des carbapénèmases, deux des bêta-lactamases AmpC mais aucun isolat ne produisait de métallo-bêta-lactamases. Malgré une faible prévalence de l'infection à A. baumannii dans cet hôpital, le profil de résistance aux antibiotiques laisse penser que la prévention de la transmission de l'infection à Acinetobacter spp. multirésistante associée aux soins de santé est essentielle.

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Background and study aim: Spontaneous bacterial peritonitis (SBP) is an important cause of morbidity and mortality in cirrhotic patients with ascites. The diagnosis of SBP is based on PMN leukocyte cell count exceeding 250/μL in ascitic fluid. However, this procedure is time consuming as well as subjective. C-reactive protein (CRP) has been reported to be a reliable predictor of SBP and an index of therapeutic effectiveness in adults. Ascitic fluid calprotectin reliably predicts PMN count >250/μL, which may prove useful in the diagnosis of SBP. This work was planned aiming to evaluate both ascitic fluid calprotectin and serum CRP as accurate diagnostic laboratory markers for detecting SBP Patients and Methods: From 140 patients; only 124 patients with ascites were included in this study. They were divided into SBP group including 70 patients (49 males and 21 females) and non-SBP group of 54 patients (25 males and 29 females). Serum CRP was determined by latex agglutination and ascitic fluid calprotectin was measured using an enzyme-linked immunosorbent assay. Results: Ascitic fluid calprotectin and serum CRP were significantly higher in SBP patients in comparison with the non-SBP group (754.67 ±256.06 vs. 280.77 ±230.97 and 62.4 ±28.39 vs. 9.81 ±8.98) respectively. In addition, both were positively correlated with ascitic fluid proteins and PMN count as well as with each other. At a cutoff value of 270 mg/dl, ascitic fluid calprotectin had 86% specificity and 97.5% sensitivity for detecting SBP [Area under the receiver operating characteristics curve (AUC) = 0.924 with negative and positive predictive values (NPV, PPV) for ascitic calprotectin 96% and 69% respectively. Conclusion: Ascitic fluid calprotectin and serum CRP may be used as accurate and reliable markers for the diagnosis of SBP.