Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites

Luke T. Evans, W. Ray Kim, John J. Poterucha, Patrick Sequeira Kamath

Research output: Contribution to journalArticle

163 Citations (Scopus)

Abstract

The prevalence and natural history of spontaneous bacterial peritonitis in asymptomatic patients with ascites secondary to cirrhosis is unknown. From a prospectively recorded database, we reviewed the clinical and laboratory features of all outpatients with cirrhotic ascites undergoing paracentesis between July 1994 and December 2000. The prevalence of spontaneous bacterial peritonitis in the population of 427 cirrhotic outpatients as defined by neutrocytic ascites (absolute neutrophil count ≥250 cells/mm 3) was 3.5%. Of the 15 patients with neutrocytic ascites, 6 were culture positive (1.4%) and 9 culture negative (2.1%). Eight other patients (1.9%) had bacterascites. The organisms cultured from ascitic fluid in these asymptomatic patients with culture positive neutrocytic ascites and bacterascites were predominantly gram positive. No patient developed hepatorenal syndrome, and 1-year survival of 67% was better than historical data from hospitalized patients with spontaneous bacterial peritonitis. Moreover, patients who did not receive antibiotics for neutrocytic ascites fared no worse than patients who did receive antibiotics. In conclusion, spontaneous bacterial peritonitis in outpatients with cirrhotic ascites is less frequent, occurs in patients with less advanced liver disease, and may have a better outcome than its counterpart in hospitalized patients. In addition, the organisms cultured from ascitic fluid in outpatients are predominantly gram positive. A reassessment of diagnostic criteria for spontaneous bacterial peritonitis in outpatients may be required.

Original languageEnglish (US)
Pages (from-to)897-901
Number of pages5
JournalHepatology
Volume37
Issue number4
DOIs
StatePublished - Apr 1 2003

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Peritonitis
Ascites
Outpatients
Ascitic Fluid
Hepatorenal Syndrome
Anti-Bacterial Agents
Paracentesis
Liver Diseases
Neutrophils
Fibrosis
Cell Count
Databases
Survival

ASJC Scopus subject areas

  • Hepatology

Cite this

Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites. / Evans, Luke T.; Kim, W. Ray; Poterucha, John J.; Kamath, Patrick Sequeira.

In: Hepatology, Vol. 37, No. 4, 01.04.2003, p. 897-901.

Research output: Contribution to journalArticle

Evans, Luke T. ; Kim, W. Ray ; Poterucha, John J. ; Kamath, Patrick Sequeira. / Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites. In: Hepatology. 2003 ; Vol. 37, No. 4. pp. 897-901.
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