Spontaneous bacterial peritonitis, causes and antibiotic usage in Srinagarind hospital

Spontaneous bacterial peritonitis (SBP) is a common and often fatal complication occurring in cirrhotic patients with ascites. It is defined as an infection of the ascitic fluid in the absence of any obvious intra-abdominal source. This study was a descriptive retrospective study that examined signs and symptoms of SBP, prevalence, result of the culture and antibiotic susceptibility of the organisms and outcome of antibiotic treatment, especially to ampicillin-aminoglycoside. Data were collected from inpatient medical records at Srinagarind Hospital between 1993 and 1997. Forty-four patients with 54 episodes of SBP were included in this study. The results revealed that SBP commonly occurred in cirrhotic patients. Presenting symptoms of SBP were fever, abdominal pain and abdominal distension, respectively. Signs of SBP were ascites and rebound abdominal tenderness. Forty-three per cent of ascitic fluid cultures were positive for bacteria E. coli (30.4%), Streptococcus spp (26.1%) and Klebsiella spp (13.0%) were the most common causes of SBP which were similar to other studies. Ampicillin plus an aminoglycoside were mostly often used in this study; in only 15.8 per cent of patients did the antibiotics need to be changed. Mortality rate in this group was not increased after antibiotic was changed.