A 42-year-old man with Child-Pugh Class C alcoholic cirrhosis presented with a 2-day history of fever and fatigue and was diagnosed with spontaneous bacterial peritonitis (SBP). An ascitic fluid analysis showed a white blood cell count of 707 /μL, with 67% neutrophils. Gram staining of the ascitic fluid revealed polymorphonuclear leukocytes but no evidence of bacteria (Picture 1). Ascites resulted in no growth of bacteria, additional blood culture bottles with ascitic fluid were positive, and Gram-positive cocci in chains were isolated, which were identified as Streptococcus salivarius (Picture 2). SBP is a common complication in cirrhosis patients. The conventional method of preparing ascitic fluid cultures from patients with suspected SBP helps in detection in only 42-65% of cases (1). Appropriate handling of ascitic fluid requires bedside inoculation into aerobic and anaerobic blood culture bottles, which increases the yield of positive culture results by 91% and speeds up detection (2). The use of blood culture bottles for the identification of the causative organism in patients with suspected SBP is important for enabling the administration of appropriate antimicrobial therapy.
Picture 1.
Picture 2.
The author states that he has no Conflict of Interest (COI).
Acknowledgment
The authors thank the clinical staff at Shiname University Hospital for their excellent work.
References
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