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Antibiotic susceptibility of asymptomatic spontaneous bacterial peritonitis in decompensated liver cirrhosis: A prospective study

Background and aim Asymp to matic spontaneous bacterial peritonitis (SBP) is rare but has similar variants to symptomatic SBP. Our aim is to determine the antibiotic susceptibility in asymptomatic SBP. Patients and methods Patients with decompensated liver cirrhosis were included in our study. Ascitic fluid analysis for polymorphonuclear count, as well as culture was done at baseline and 48 h after antibiotic initiation if polymorphonuclear count more than or equal to 250/mm3 and/or positive culture. Cefotaxime was used empirically, whereas in bacterascites, initial antibiotic was based on the culture. Results A total of 70 patients were included. Approximately 15.7% had asymptomatic SBP. Overall, 9% of patients with asymptomatic SBP were classic SBP, culture-negative neutrocytic ascites (CNNA) in 54.5%, and bacteriascites in 36.4%. Classic SBP and five cases of CNNA were cefotaxime sensitive. The resistant case in CNNA responded to meropenem. Bacterascites was cefotaxime resistant and sensitive to ciprofloxacin and piperacillin-tazobactam. The overall resistance to cefotaxime was 45.5%. Conclusion CNNA is predominant in asymptomatic SBP with high resistance to third-generation cephalosporin which requires antibiotic susceptibility to be identified before therapy.