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World J Gastroenterol. Sep 28, 2006; 12(36): 5890-5892
Published online Sep 28, 2006. doi: 10.3748/wjg.v12.i36.5890
Organisms causing spontaneous bacterial peritonitis in children with liver disease and ascites in Southern Iran
Mahmood Haghighat, Seyed Mohsen Dehghani, Abdolvahab Alborzi, Mohammad Hadi Imanieh, Bahman Pourabbas, Mehdi Kalani
Mahmood Haghighat, Seyed Mohsen Dehghani, Mohammad Hadi Imanieh, Department of Pediatric Gastroenterology, Shiraz University of Medical Science, Shiraz, Iran
Abdolvahab Alborzi, Bahman Pourabbas, Mehdi Kalani, Department of Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Science, Shiraz, Iran
Author contributions: All authors contributed equally to the work.
Correspondence to: Seyed Mohsen Dehghani, Department of Pediatric Gastroenterology, Shiraz University of Medical Science, Shiraz, Iran. dehghanism@sums.ac.ir
Telephone: +98-711-6242534 Fax: +98-711-6265024
Received: July 12, 2006
Revised: August 15, 2006
Accepted: August 23, 2006
Published online: September 28, 2006
Abstract

AIM: To determine the causative agents of spontaneous bacterial peritonitis (SBP) in children with liver disease and ascites in our center.

METHODS: During a 2.5 year period, from September 2003 to March 2006, 12 patients with 13 episodes of SBP were studied. In all cases at the time of admission serum albumin and glucose, urinalysis and urine culture was performed. Analysis [white blood cell (WBC) count with differential, albumin, glucose], gram stain, culture by BACTEC method and antibiogram was done on ascitic fluids. Abdominal paracentesis was repeated after 48 h of antibiotic therapy for bacteriologic assay. The patients were followed for at least three months in a gastroenterology clinic.

RESULTS: There were 7 girls (58%) and 5 boys (42%) with a median age of 5.2 years (range, 6 mo to 16 years). All cases had positive ascitic fluid culture. Gram stain was positive in 5 (38.5%) of them. The isolated organisms were S. pneumoniae in 5 (38.5%), E. coli in 2 (15.3%), S. viridans in 2 (15.3%), and K. pneumoniae, H. influenza, Enterococci, and nontypable Streptococcus each in one (7.7%). All of them except Enterococci were sensitive to ciprofloxacin and ceftriaxone. All ascitic fluid cultures were negative after 48 h of antibiotic therapy.

CONCLUSION: S. pneumoniae is the most common cause of SBP in the pediatric age group and we recommend a third generation cephalosporine (e.g., Ceftriaxione or Cefotaxime) for empirical therapy in children with SBP.

Keywords: Spontaneous bacterial peritonitis; Children; Cirrhosis; Causes; Empirical therapy