Abstract
The definitive diagnosis of spontaneous bacterial peritonitis is made by a positive ascitic fluid culture. Causative organisms cannot be isolated in up to 65% of patients with well-defined spontaneous bacterial peritonitis, probably due to inadequate ascites culture techniques. We prospectively compared two ascites culture methods: conventional (on chocolate agar and thioglycolate broth) and modified (inoculation of 10 ml of ascites in a tryptic soy broth blood culture bottle at the patient's bedside). In a 10-month period, 31 cirrhotic patients met our diagnostic criteria for spontaneous bacterial peritonitis; both culture methods were performed on their ascitic fluid. The conventional method grew bacteria in only 16 of the 31 episodes (52%), whereas the modified method grew bacteria in 25 (81%), a significantly higher sensitivity (P less than 0.05). The modified method also shortened significantly the time for detection of bacterial growth. We conclude that ascites inoculation into a blood culture bottle at the patient's bedside should be the routine method for ascites culture.
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Selected References
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- Conn H. O., Fessel J. M. Spontaneous bacterial peritonitis in cirrhosis: variations on a theme. Medicine (Baltimore) 1971 May;50(3):161–197. doi: 10.1097/00005792-197105000-00002. [DOI] [PubMed] [Google Scholar]
- Garcia-Tsao G., Conn H. O., Lerner E. The diagnosis of bacterial peritonitis: comparison of pH, lactate concentration and leukocyte count. Hepatology. 1985 Jan-Feb;5(1):91–96. doi: 10.1002/hep.1840050119. [DOI] [PubMed] [Google Scholar]
- Hoefs J. C., Canawati H. N., Sapico F. L., Hopkins R. R., Weiner J., Montgomerie J. Z. Spontaneous bacterial peritonitis. Hepatology. 1982 Jul-Aug;2(4):399–407. doi: 10.1002/hep.1840020402. [DOI] [PubMed] [Google Scholar]
- Hoefs J. C., Runyon B. A. Spontaneous bacterial peritonitis. Dis Mon. 1985 Sep;31(9):1–48. doi: 10.1016/0011-5029(85)90002-1. [DOI] [PubMed] [Google Scholar]
- Pinzello G., Simonetti R. G., Craxì A., Di Piazza S., Spanò C., Pagliaro L. Spontaneous bacterial peritonitis: a prospective investigation in predominantly nonalcoholic cirrhotic patients. Hepatology. 1983 Jul-Aug;3(4):545–549. doi: 10.1002/hep.1840030411. [DOI] [PubMed] [Google Scholar]
- Runyon B. A., Canawati H. N., Akriviadis E. A. Optimization of ascitic fluid culture technique. Gastroenterology. 1988 Nov;95(5):1351–1355. doi: 10.1016/0016-5085(88)90372-1. [DOI] [PubMed] [Google Scholar]
- Runyon B. A., Hoefs J. C. Ascitic fluid analysis in the differentiation of spontaneous bacterial peritonitis from gastrointestinal tract perforation into ascitic fluid. Hepatology. 1984 May-Jun;4(3):447–450. doi: 10.1002/hep.1840040316. [DOI] [PubMed] [Google Scholar]
- Runyon B. A., Hoefs J. C. Culture-negative neutrocytic ascites: a variant of spontaneous bacterial peritonitis. Hepatology. 1984 Nov-Dec;4(6):1209–1211. doi: 10.1002/hep.1840040619. [DOI] [PubMed] [Google Scholar]
- Runyon B. A., Umland E. T., Merlin T. Inoculation of blood culture bottles with ascitic fluid. Improved detection of spontaneous bacterial peritonitis. Arch Intern Med. 1987 Jan;147(1):73–75. [PubMed] [Google Scholar]
- Washington J. A., 2nd, Ilstrup D. M. Blood cultures: issues and controversies. Rev Infect Dis. 1986 Sep-Oct;8(5):792–802. doi: 10.1093/clinids/8.5.792. [DOI] [PubMed] [Google Scholar]