الفهرس 
Introduction and Aim of the WorkOnly 14 pages are availabe for public view
 |  | from | 140 |  |  |
| | | from | 140 | | |
Abstract
SUMMARY
Spontaneous bacterial peritonitis (SBP) is a frequent and
severe complication of decompensated cirrhosis, polymorphonuclear
(PMN) cell count in the ascitic fluid is essential for its diagnosis and
management. Following the clinical diagnosis of SBP, ascitic fluid
collection and blood cultures should be carried out before initiating
antibiotic administration.
Tween 80 and Triton X-100 are 100% pure, non-anionic
surfactant agents. They are believed to yield a better growth of
organisms as compared with direct plating methods.
The aim of this work is to compare between the utility of
conventional cultures, culture of ascitic fluid from blood culture
bottles, culture of specimen on media supplemented with nonanionic
surfactant agents such as Tween 80 and culture of specimen
treated with Triton X-100 in diagnosis of ascitic fluid infection.
This study was conducted on 140 samples of ascitic fluid
collected from the Microbiology Laboratory of Ain Shams
University Hospitals for routine culture and susceptibility testing.
The collected samples were subjected to macroscopic and
microscopic examination, conventional culture on blood agar and
MacConkey agar, culture using Oxoid blood culture bottles, culture
on blood agar supplemented with 2% Tween 80 and culture of
treated specimens with Triton X-100 on blood agar and MacConkey
agar incubated at 37°C for 48 hours.
In our study, (27/140) (19.3%) samples were diagnosed as SBP or
its variants. The most common variant was monomicrobial nonneutrocytic
bacterascites (MNB) as it was detected in (21/27) (77.8%)
Summary
١٠٨
١٠٨
of samples followed by culture negative neutrocytic ascites (CNNA)
in 11.1% (3/27), full fledged (classical) SBP in 7.4% (2/27) and
polymicrobial non-neurocytic bacterascites in 3.7% (1/27).
Conventional culture showed positive results in 17/140
(12.1%), culture on blood culture bottles showed positive results in
29/140(20.7%) while blood agar supplemented with Tween 80
showed positive results in 13/140(9.3%) and samples treated with
Triton X-100 showed positive results in 11/140 (7.9%).
There was a highly significant difference between the positive
results of conventional culture (12.1%) and culture on blood culture
bottles (20.7%) (P<0.01). Also, there was a highly significant
difference between culture on blood culture bottles (20.7%) and
culture of samples treated with Triton X-100(7.9%)(P<0.01). While,
there was no significant difference between the positive results of
conventional culture (12.1%) and each of culture on blood agar
supplemented with Tween 80 (9.3%) and samples treated with
Triton X-100 (7.9%) (P>0.05).
Conventional culture of samples was positive in 17/140
(12.1%), 9/17 (52.9%) of them were Gram positive bacteria and 5/17
(29.4%) were Gram-negative bacteria and there was mixed growth of
three Gram-negative organisms in 1/17(5.9%) and mixed growth of
both Gram-positive and Gram-negative bacteria in 2/17(11.8%). The
most commonly isolated organisms were Staphylococcus coagulase
negative in 8/11 samples (72.7%), Acinetobacter in 3 samples (30%)
and E. coli in 3 samples (30%). Whereas Enterococci, Klebsiella and
Citrobacter were the least common; each was isolated from only one
sample (9.1%, 10%, 10% respectively).
Culture of samples on blood culture bottles showed growth in
29/140 (20.7%); of which 19/29 (65.5%) were Gram-positive bacteria
and 7/29 (24.1%) were Gram-negative bacteria and there was mixed
growth of three Gram-negative organisms in 1/29(3.5%) and mixed
growth of both Gram-positive and Gram-negative bacteria in 2/29
(6.9%). The most common isolated organisms were Staphylococcus
coagulase negative in 14/21 samples (66.7%), Enterococci in 5 samples
(23.8%), Acinetobacter in 4 samples (33.3%) and E.coli in 4 samples
(33.3%). Whereas the least common isolated organisms were Klebsiella
and Citrobacter each was isolated from only one sample (8.3%).
Culture on blood agar supplemented with Tween 80 showed
growth in 13/140 (9.3%); out of which 6/13(46.1%) were Grampositive
bacteria and 6/13(46.1%) were Gram-negative bacteria and
there was mixed growth of both Gram-positive and Gram-negative
bacteria in 1/13 (7.8%). The most common isolated organisms were
Staphylococcus coagulase negative in 3 samples (42.8%), and
Staphylococcus aureus, Enterococci, Acinetobacter and E.coli each
was isolated from 2 samples (28.6%). Whereas the least common
isolated organisms were Pseudomonas, Klebsiella and Citrobacter;
each was isolated from only one sample (14.3%).
Culture of samples treated with Triton X- 100 showed growth
in 11/140(7.9%); out of which 4/11(36.4%) were Gram-positive
bacteria and 5/11(45.4%) were Gram-negative bacteria and there was
mixed growth of three Gram-negative organisms in 1/11(9.1%) and
mixed growth of both Gram-positive and Gram-negative bacteria in
1/11 (9.1%). The most common isolated organisms were Staph.
aureus and Enterococci each was isolated from 2 samples (40%)
followed by Acinetobacter and E. coli (3/9) (33.3% each). Whereas
the least common isolated organisms were Pseudomonas, Klebsiella,
and Citrobacter; each was isolated from only one sample (11.1%).
In this study, there was no significant difference between
samples with cell count <250 cells/mm3 and those with cell count
>250 cells/mm3 as regards the results of culture by the four studied
methods. Also, there was no significant difference between results of
positive culture taken from cases with and without antibiotic intake
by all types of cultures studied.
There was a highly significant difference between
conventional culture and culture on blood culture bottles or culture
on blood agar supplemented with Tween 80, as regard rates of
detection of Gram-positive bacteria. While there was no significant
difference between conventional culture and culture of samples
treated with Triton X-100.
There was no significant difference between different types of
culture as regard rates of detection of Gram-negative bacteria.