Asymptomatic bacterascites: Is it spontaneous bacterial peritonitis?

Abstract

Asymptomatic bacterascites is defined as the presence of bacteria in ascitic fluid without clinical features of peritonitis or increased ascitic fluid polymorphonuclear cells. Asymptomatic bacterascites is a controversial entity, and little information is available regarding its spontaneous evolution. Clinical features, bacteriological data and outcome in 22 cirrhotic patients with asymptomatic bacterascites are reported and are compared with those of a group of 36 cirrhotic patients with spontaneous bacterial peritonitis. Eleven patients had gram-negative bacteria and 11 had one gram-positive bacteria. Only in three patients (13.6%) did peritonitis develop. Twelve patients received no antibiotic therapy, and in none did peritonitis develop. At 1 month, 27% of patients with asymptomatic bacterascites had died. Patients with asymptomatic bacterascites had less-severe liver disease; they more frequently had gram-positive bacteria in ascitic fluid and had a lower 1-mo mortality rate than did patients with spontaneous bacterial peritonitis. We conclude that asymptomatic bacterascites is usually the transient residence of bacteria in ascitic fluid. Peritonitis rarely develops in patients with asymptomatic bacterascites and, in most of them, antibiotic therapy is not required.

Rapid Identification of Bacterial Species with Bacterial DNA Microarray in Cirrhotic Patients with Spontaneous Bacterial Peritonitis

“…Cl i n i c a l a n d L a b o r a t o r y Da t a a t P a r a c e n t e s (20,21). Bacterial identification † r e f e r e n c e v a l u e : i mp e r f e c t ma t c h i n g S B P : s p o n t a n e o u s b a c t e r i a l p e r i t o n i t i s , C NNA: c u l t u r e n e g a t i v e n e u t …”

Spontaneous Bacterial Peritonitis

“…Organ systems outside the gastrointestinal tract can be affected. Mental status changes, which may be subtle, occur in 50% [39,41] , and decrements in renal function are seen in one-third of cases [42] . Shock at the time of presentation is a rare event [38] , probably as a result of the current lower threshold to perform diagnostic paracentesis and earlier diagnosis.…”

“…Therefore, patients with a clinical presentation suggesting infection, even with an initial ascitic fl uid PMN count ! 250 cells/mm 3 , should be treated with empirical antibiotics [41,44] . As soon as the ascitic fl uid culture returns demonstrating growth of bacteria, a repeat paracentesis should be performed if antibiotics had not been started (i.e.…”

To study the relation between spontaneous bacterial peritonitis and serum ascitis albumin gradient in chronic liver disease patients

“…12 In other study, Pelletier et al, found 89% of patients were having fever, UGI bleed (42%) 53% patients had pain abdomen, and 50% cases had hepatic encephalopathy. 13 One thing that was common in all the studies were the clinical features. These were more common in SBP group in comparison to patients with sterile cirrhotic ascites.…”