IDDF2019-ABS-0228 Community acquired spontaneous bacterial peritonitis in cirrhotic patients: microbiological diagnosis and molecular concordance with bacteremia. (June 2019)

• Record Type: Journal Article
• Authors: Mahanta, Bipanchi; Das, Anup; Nath, Reema
• Is Part Of: Gut. Volume 68(2019)Supplement 1
• Page Start: A106
• Page End: A106
• Publication Date: 2019-06
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2019-IDDFAbstracts.202
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Background: About 10–30% of Cirrhotic patients with ascites develop spontaneous bacterial peritonitis (SBP) within a year and many are community acquired. Isolation of bacteria from ascitic fluid is low to get antibiogram for choosing antibiotic. INASL recommends Ceftriaxone for empirical therapy in SBP. However, ESBL production in enteric bacteria has complicated the treatment. Aims: To establish bacterial etiology of community-acquired SBP and choose a sampling procedure to enhance bacterial demonstration and isolation. To determine the antibiotic susceptibility pattern of the bacterial isolates. To establish the concordance between bacteria causing peritonitis and bacteremia using molecular tools. Subjects: Twenty-six consecutive clinically suspected community-acquired SBP cases, attending OPD within 6 months, in a tertiary hospital of Northeast India without the history of antibiotic therapy were enrolled. Methods: In this Cross-sectional observational study peritoneal fluid was collected in sterile container and culture bottles in duplicate with two sets of blood culture. Smears were prepared at bedside and laboratory. Culture isolates were identified conventionally. Antimicrobial sensitivity was performed using the Kirby Bauer method and tested for ESBL production. Similar Organisms from blood and ascitic fluid were confirmed by PCR using16s rRNA primers. Sanger sequencing was done and evolutionary analysis done by Maximum Likelihood method. Fisher's exact test done using GraphPad Quick Cals software. Results: Gram stains done in bedside smears showed higher (84.6%) bacterial detection rate than done at the laboratory (30.7%). Bacterial isolation was significantly higher (46.42%) from Ascitic fluid collected in the culture bottle than in a sterile container (3.57%). Escherichia coli isolation was highest (30.7%) followed by Klebsiella pneumoniae (19.23%) and Staphylococcus aureus (15.38%). All Klebsiella pneumoniae and 80% of E.coli were ESBL producers and resistant to Cephalosporin and Quinolones (>80%). Beta lactams with Beta lactamase inhibitor showed 60–70% sensitivity. Molecular and antibiogram typing showed 66% homogeneity between similar bacteria causing SBP and bacteremia. Conclusions: Bedside smear and inoculation in suitable enrichment broth was better for bacterial detection and isolation. Bacteria causing SBP were ESBL producers warranting locally specific treatment guideline for empiric therapy. Simultaneous SBP and bacteremia by a similar organism are not rare. Further studies are needed to modify INASL guidelines.