الفهرس 
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Abstract
Liver cirrhosis and ascites are common problems among
Egyptians specially farmers. The cause of chronic liver disease
is multifactorial including schistosomiasis and/or viral hepatitis.
Spontaneous ascitic infection is an infection in a
previously sterile ascitic fluid with no apparent intra abdominal
source of infection.
Antibiotic-resistant microorganisms have been
increasingly reported especially to cefotaxime and its effects on
the clinical outcome in treating spontaneous bacterial peritonitis
In our study 40 patients with liver cirrhosis and ascites and
clinical findings suspicious of ascetic fluid infection were
admitted were admitted to Hepatology & Gastroenterology
inpatient department , Beni-Sueif University hospital for
research and treatment and underwent abdominal diagnostic
paracentesis.
Full history, thorough clinical examination and routine
laboratory investigations including blood picture, liver and
kidney function tests together with chemical, bacteriological and
cytological examination of the ascetic fluid.
Tretment: with cefotaxime, as empirical treatment with
maximum dose 2gm IV, every 8 hours start just after taking
ascitic fluid sample for 5days.
Follow up: Total cell count and polymorpho-nuclear
leucocyte count after 5 days to assess the response to cefotaxime
or usage of alternative antibiotic according to culture and
sensitivity.
They were classified according to polymorpho-nuclear
leukocytic (PMN) count cells/mm³ and culture to the 3 groups, 9
Summary
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patients (22.5%) were diagnosed as SBP (group I), 30 patients
(75%) were diagnosed as CNNA (group II), 1 patient (2.5%)
had monomicrobial non-neutrocytic ascites (group III).
There were no statistical significant difference between the
studied groups as regards age and sex, Prior history of ascetic
fluid infections, History of antibiotic prophylaxis, History of
iatrogenic procedures (canuola or catheter), Lack of response to
diuretics, History of diagnostic or therapeutic paracentesis,
hepatic encephalopathy, fever and Gastrointestinal bleeding.
Regarding TLC and Total bilirubin There was no
statistically significant difference between group I,II,III (P
>0.05).
As regards ascetic fluid chemical analysis SAAG was
1.1g/dL in group I, II, II.
Gram negative organism was the most frequenttly detected
organism (77.8%).
E.choli was the most frequently detected organism in the
infected group.
Cefotaxime suggested as the first-line empiric antibiotic
treatment failed in 66.7% of our cases (organism was not
sensitive to cefotaxime in invitro culture and sensitivity).
According to culture and sensitivity; Amikacin was found
to be the most sensitive antibiotic with sensitivity 66.6% in 6
cases, imepenem was sensitive in 4 cases (44.4%),
it is important to conclude that cefotaxime effectiveness in
treating spontaneous bacterial peritonitis in our Egyptian
patients had been decreased and failure rate was more than
Summary
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(66%) and isolated organisms mostly invitro sensitive to
Amikacin.
We recommend Further studies needed to asses Amikacin
as an empirical treatment of SBP since the isolated organisms
were mostly invitro sensitive to it.