Patterns of Ascites Fluid Infections, Etiology and Antimicrobial Profile among Adult Cirrhosis Patients Attending at St. Paul Specialized Hospital Millennium and Yekatit 12 Hospital Medical Colleges, Addis Ababa, Ethiopia
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Date
2021-09
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Addis Abeba University
Abstract
Background: Ascites is one of the most common complications in patients with cirrhosis. Ascites fluid infections are common and potentially life-threatening infections frequentlyencountered in patients with cirrhotic ascites. The diagnosis of ascetic fluid infections is basedon the number of polymorph nuclear neutrophil (PMN)) cells and the result of ascetic fluidculture.
Objective: The main objective of this study was to evaluate the pattern, clinical andmicrobiological profile of Spontaneous ascites fluid infection (SAFI), in patients with livercirrhosis attending at selected public hospital from March 2020 to March 2021.
Methods: Hospital based cross sectional study was conducted from March 2020 to March 2021.Saint Paul Specialized Hospital and Yekatit 12 hospital medical colleges were chosen bypurposive sampling method. Cirrhosis patients with ascites who presented to the hospitals wereconveniently enrolled and consecutively recruited. Structured questionnaire was used to collectdemographic data, clinical diagnosis and laboratory investigation. Culture and drug resistantpattern studied following standard methods. Data was analyzed using statistical software IBM(SPSS 23) and multinomial regression analysis was done to assess association between outcome and explanatory variables.
Results: 51 out of 218 patients (23.34%) were found to have SAFI, out of which 19 (37.3%)were female and 32 (62.7) were male. 40 (78.43%) patients had Culture Negative Neutrocyticascites (CNNA), 11 (21.57 %) had Classic SBP (Spontaneous bacterial peritonitis) and 1 (2.0%)had Bacterascites. Gram negative (mainly Escherichia coli n=4 (36.36%), and Klebsiellapnuemoniae n=3 (27.27%)), and Staphyloccus aureus n=1 (9.09%), Streptococcus viridans n=1(9.09) and CoNs (coagulase negative staphs) n=2 (18.27) . Most identified E.coli were resistantto Ceftriaxone. Abdominal distension (62%), pedal oedema (60%), abdominal pain (62%) andjaundice (52) were the main clinical features in those with SAFI. History of jaundice, fever, lowserum Albumin, high ALT, and low Ascites fluid albumin were among independent predictors.
Conclusion: Spontaneous Ascites fluid infection (SAFI) was common among cirrhotic patientswith ascites attended at SPSHMMC and Yekatit 12 hospital medical college. Jaundice, low arterial blood pressure, low platelet, low serum albumin, and low Ascites fluid albumin were amonghighly indicative SAFI and diagnostic paracentesis should be done instantly on admission to confirm thediagnosis preferably before starting empiric antibiotic therapy to enhance culture positive rate.
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Cirrhosis patients, spontaneous bacterial peritonitis, Drug susceptibility, Addis Ababa.