Spontaneous bacterial peritonitis and bacterascites prevalence in asymptomatic cirrhotic outpatients undergoing large-volume paracentesis


Dr Jose Castellote, Servei d'Aparell Digestiu, IDIBELL, Hospital Universitari de Bellvitge, C/Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. Email: jcastellote@csub.scs.es


Background and Aim:  Spontaneous bacterial peritonitis and bacterascites prevalence in asymptomatic cirrhotic patients on large-volume paracentesis is unknown. The aim of this study was to investigate spontaneous bacterial peritonitis and bacterascites prevalence in a prospective cohort of cirrhotic outpatients following large-volume paracentesis with low risk of infection.

Methods:  We prospectively studied all large-volume paracenteses performed in cirrhotic outpatients for 1 year. Patients with fever, abdominal pain, peritonism or hepatic encephalopathy were excluded from the study. The ascitic fluid was analyzed by means of a reagent strip with a colorimetric scale from 0 to 4. A strip test of 0 or 1 was considered negative. In those cases with a reagent strip ≥2, conventional polymorphonuclear count was performed. Ascitic fluid culture was done into blood culture bottles in all cases.

Results:  We performed 204 paracenteses in 40 patients. Nine cases were excluded. Culture-negative neutrocytic ascites was diagnosed in one case (0.5%), while bacterascites was diagnosed in six out of 195 cases (3%), mainly by gram-positive cocci.

Conclusion:  The spontaneous bacterial peritonitis prevalence in outpatient cirrhotics with low risk of infection undergoing large-volume paracentesis is very low. Moreover, the prevalence of bacterascites is low and without clinical consequences. The routine analysis of ascitic fluid may be unnecessary in this clinical setting. Nevertheless, the use of reagent strips is a reasonable alternative due to its accessibility and low cost.