Prevalence of Spontaneous Bacterial Peritonitis in Chronic Liver Disease at BMC SPH, Quetta

Abstract

Background: Spontaneous bacterial peritonitis (SBP) is a frequent and life-threatening infection of ascitic fluid in chronic liver disease (CLD), contributing substantially to in-hospital morbidity and mortality. Local epidemiologic and microbiologic data are essential to guide early diagnostic vigilance and empiric antimicrobial therapy in hospitalized patients with cirrhosis and ascites. Objective: To determine the frequency of SBP among hospitalized CLD patients with ascites at Sendeman Provincial Hospital/BMC Quetta and to describe ascitic fluid culture yield and bacterial spectrum. Methods: A cross-sectional observational study was conducted in the Department of General Medicine, Unit IV, Sendeman Provincial Hospital/BMC Quetta from 06 January 2025 to 06 June 2025. Consecutive patients aged >15 years with CLD and ascites underwent diagnostic paracentesis within 24 hours of admission. Ascitic fluid (50 mL) was obtained under aseptic technique; 10 mL was inoculated directly into blood culture bottles and the remainder was analyzed for cell count/differential. SBP was diagnosed using standard criteria (ascitic polymorphonuclear leukocytes ≥250 cells/mm³) and infections were categorized by PMN count and culture status. Results: Among 139 patients (mean age 35.67±12.79 years; 61.0% male), SBP was present in 56 (40.3%). Ascitic fluid culture was positive in 80 (57.6%). Among culture-positive infections (n=80), classical SBP accounted for 52 (65.0%), bacterascites for 18 (22.5%), and culture-negative neutrocytic ascites for 10 (12.5%). Escherichia coli was the most common isolate (30/80, 37.5%), followed by Klebsiella species (15/80, 18.8%). Conclusion: SBP occurred in approximately two-fifths of hospitalized CLD patients with ascites, with predominance of classical SBP and enteric gram-negative pathogens, supporting routine early paracentesis and locally informed empiric management.