TY - JOUR
T1 - Secondary Bacterial Peritonitis in Cirrhotic Patients with Ascites
AU - Caralis, Potoula V.
AU - Sprung, Charles L.
AU - Schiff, Eugene R.
PY - 1984/5
Y1 - 1984/5
N2 - Bacterial peritonitis in patients with cirrhosis has a wide variety of clinical presentations. We report a group of 21 cirrhotic patients with secondary peritonitis from intraabdominal sources. Seven had infected ascites. All of them had unrecognized secondary peritonitis which was diagnosed and treated as spontaneous (primary) bacterial peritonitis (SBP). Ascitic fluid analysis yielded a mean white blood cell count of 23,750 ± 10,935/cu mm with 91.5% polymorphonuclear leukocytes, significantly higher than patients surveyed with SBP, 1,757 ± 2,154/cu mm (P < .001). Ascitic fluid protein levels were also higher than those typically seen in SBP: 4.4 ± 1.5 gm/dl vs 0.8 ± 0.4 gm/dl (P < .001). The ascites:serum protein ratio was consistent with an exudate in those patients with secondary peritonitis (0.7 ± 0.2) in contrast to typically infected transudate in patients with SBP (0.15 ± 0.05) (P < .001). Bacteriologic determination was similar: single organisms with Escherichia coli the most common. Often the clinical features and ascitic fluid analysis will not differentiate spontaneous from secondary peritonitis. It is, therefore, clinically prudent to consider secondary bacterial peritonitis in cirrhotic patients, especially with ascitic fluid WBC counts in excess of 5,000/cu mm and protein levels of ≥ 2.5 gm/dl. Noninvasive diagnostic procedures should be included to search for sources of intra-abdominal infection.
AB - Bacterial peritonitis in patients with cirrhosis has a wide variety of clinical presentations. We report a group of 21 cirrhotic patients with secondary peritonitis from intraabdominal sources. Seven had infected ascites. All of them had unrecognized secondary peritonitis which was diagnosed and treated as spontaneous (primary) bacterial peritonitis (SBP). Ascitic fluid analysis yielded a mean white blood cell count of 23,750 ± 10,935/cu mm with 91.5% polymorphonuclear leukocytes, significantly higher than patients surveyed with SBP, 1,757 ± 2,154/cu mm (P < .001). Ascitic fluid protein levels were also higher than those typically seen in SBP: 4.4 ± 1.5 gm/dl vs 0.8 ± 0.4 gm/dl (P < .001). The ascites:serum protein ratio was consistent with an exudate in those patients with secondary peritonitis (0.7 ± 0.2) in contrast to typically infected transudate in patients with SBP (0.15 ± 0.05) (P < .001). Bacteriologic determination was similar: single organisms with Escherichia coli the most common. Often the clinical features and ascitic fluid analysis will not differentiate spontaneous from secondary peritonitis. It is, therefore, clinically prudent to consider secondary bacterial peritonitis in cirrhotic patients, especially with ascitic fluid WBC counts in excess of 5,000/cu mm and protein levels of ≥ 2.5 gm/dl. Noninvasive diagnostic procedures should be included to search for sources of intra-abdominal infection.
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U2 - 10.1097/00007611-198405000-00010
DO - 10.1097/00007611-198405000-00010
M3 - Article
C2 - 6372107
AN - SCOPUS:0021339451
VL - 77
SP - 579
EP - 583
JO - Southern Medical Journal
JF - Southern Medical Journal
SN - 0038-4348
IS - 5
ER -