الفهرس 
List of contentsOnly 14 pages are availabe for public view
 |  | from | 95 |  |  |
| | | from | 95 | | |
Abstract
The current study was prospectively performed in the Department of Tropical Medicine & Gastroenterolgy at AL-Rajhi University Liver Hospital, Assiut University in the period between June 2016 and June 2017. Frequency of SBP in the current study was 35.3% (53 out of 150 patients). Mean age of patients with SBP was 57.26 ± 14.15. There were no significant difference between SBP and non SBP groups regarding age, sex, residence and co morbidities. About 60.4% of positive cases had first episode and 39.6 % had recurrent SBP. Majority of SBP cases were Child C (46 out of 53) (86.8%) while the remaining 7 (13.2%) cases were child B Cirrhotic patients with ascites who presented with fever, abdominal pain and abdominal tenderness should be investigated for the higher possibility of having SBP.
As regard laboratory studies: there were significant difference between SBP and non SBP groups including total bilirubin, total protein, serum albumin, coagulation profile and CRP as total bilirubin and CRP were significantly higher while total protein and serum albumin were significantly lower in SBP group. Also, coagulation profile was significantly impaired in SBP group. Regarding to imaging studies: frequency of turbid ascites was significantly higher in SBP group (52.8%) in comparison to non SBP group (37.1%) However, there was no significant difference between both group as regard degree of ascites. The present study suggests that the development of spontaneous bacterial peritonitis in cirrhotic patients with sterile ascites is directly related to ascites albumin concentration. Patients with SBP, had significantly lower level of ascitic fluid albumin in comparison to non SBP patients. Regarding to the severity of liver disease, we found that Child score and MELD score were significantly higher in those patients with SBP. In addition, frequency of Child C class was significantly higher in patients with SBP There were 3 variants of SBP: Classical type in which the ascitic culture is positive and PMNL count in ascitic fluid ≥ 250, other variant is called bacterascites in which the culture is positive but PMNL count is 250, the last variant is culture negative neutrocytic ascites in which the PMNL count is 250 but with negative culture. The most prevalent variant in the current study was the classical type in 29 (54.7%) patients followed by CNNA in 19 (35.9%) patients and finally bacterascites in 5 (9.4%) patients. Thirty four (64.15%) patients out of 53 SBP cases had positive culture and E. coli was the most common prevalent organism in culture positive cases 14 (41.1%) patients followed by Staphylococcus auereus 12 patients (35.3%), Streptococcus 4 (11.7%) patients, and finally pseudomonas in 2 (5.9%) patients and Pneumococci in 2 (5.9%) patients. All isolated organisms were sensitive to Cefotaximie (3rd generation cephalosporin) E. coli was also sensitive to Tazobactm, and Staphylococcus was also sensitive to Trimethoprim-Sulfamethoxazole. Conclusion 1-Frequency of SBP in the current study is 35.3%. 2-The frequent SBP variant in the current study was the classical one (54.7%).
3-The most common prevalent organism in culture positive cases in the current study was E coli(41.1%). 4- The current study showed that the independent predictors for SBP in patients with LC and ascites were previous history of SBP (OR= 4.56, 95%CI= 1.22- 3.33; P= 0.02) and low albumin in the ascitic fluid (OR= 2.34, 95%CI= 2.01- 4.01; P= 0.03).