Acevedo-Haro JG, Mohamed W, Moodley P, Bendall O, Bennett K, Keelty N, Chan S, Waddy S, Hosking J, Thomas W, Tilley R. Sensitivity of diagnosis of spontaneous bacterial peritonitis is higher with the automated cell count method. World J Hepatol 2024; 16(11): 1265-1281 [DOI: 10.4254/wjh.v16.i11.1265]
Corresponding Author of This Article
Juan G Acevedo-Haro, PhD, Doctor, South West Liver Unit, University Hospitals Plymouth NHS Trust, Derriford Road, Plymouth PL6 8DH, United Kingdom. jacevedo@nhs.net
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Nov 27, 2024; 16(11): 1265-1281 Published online Nov 27, 2024. doi: 10.4254/wjh.v16.i11.1265
Table 1 Type of bacteria according to their pathogenicity in spontaneous bacterial peritonitis
Bacteria
Pathogenic
Staphylococcus aureus
Enterococcus faecalis
Enterococcus faecium
Escherichia coli
Klebsiella pneumoniae
Pseudomona aeruginosa
Anaerobes
Clostridium innocuum
Streptococcus gallolyticus
Streptococcus agalactie
Indeterminate
Sphingomonas paucimobilis
Acinetobacter sp.
Streptococcus sanguinis
Streptococcus parasanguinis
Streptococcus salivarius
Non-pathogenic
Staphylococcus epidermidis
Staphylococcus capitis
Staphylococcus haemolyticus
Staphylococcus hominis
Staphylococcus saprophyticus
Staphylococcus pasteuri
Staphylococcus pettenkoferi
Staphylococcus warneri
Staphylococcus saccharolyticus
Corynebacterium striatum
Corynebacterium jeikeium
Micrococcus luteus
Dermacoccus nishinomiyaensis
Kocuria rhizophilia
Table 2 Performance of automated and manual cell count methods in cohort 2 employing different cutoffs, n (%)
SBP
Total
Positive
Negative
Manual method cell count
Result cutoff ≥ 200 cells × 106
Positive
19 (61)
0
19
Negative
12
50 (100)
62
Total
31
50
81
Result cutoff ≥ 250 cells × 106
Positive
18 (58)
0
18
Negative
13
50 (100)
63
Total
31
50
81
Result cutoff ≥ 300 cells × 106
Positive
18 (58)
0
18
Negative
13
50 (100)
63
Total
31
50
81
Automated method cell count
Result cutoff ≥ 0.1 cells × 109/L
Positive
24 (89)
26
50
Negative
3
25 (49)
28
Total
27
51
78
Result cutoff ≥ 0.2 cells × 109/L
Positive
21 (78)
2
50
Negative
6
49 (96)
28
Total
27
51
78
Result cutoff ≥ 0.3 cells × 109/L
Positive
20 (74)
0
20
Negative
7
51 (100)
58
Total
27
51
78
Result cutoff ≥ 0.4 cells × 109/L
Positive
19 (70)
0
20
Negative
8
51 (100)
58
Total
27
51
78
Table 3 Clinical and biochemical characteristics of positive-spontaneous bacterial peritonitis and negative-spontaneous bacterial peritonitis cases in cohort 1, n (%)/mean ± SD
Table 4 Markers of infection and characteristics of ascitic fluid in positive-spontaneous bacterial peritonitis and negative-spontaneous bacterial peritonitis cases in cohort 1, n (%)/mean ± SD
Negative-SBP (n = 132)
Positive-SBP (n = 5)
P value
Markers of inflammation
CRP (mg/L)
42 ± 40
59 ± 26
0.33
CRP > 5 mg/L
106 (89)
5 (100)
1.0
Leukocyte count in serum (× 109/L)
10.2 ± 6.6
7.5 ± 2.3
0.36
Neutrophil count in serum (× 109/L)
7.6 ± 5.7
5.8 ± 1.9
0.50
Temperature (°C)
37.0 ± 0.7
37.5 ± 0.3
0.14
Heart rate (beats per minute)
91 ± 15
92 ± 19
0.87
Respiratory rate (breaths per minute)
18 ± 4
19 ± 1
0.74
Presence of SIRS
33/108 (31)
0/5
0.17
MAP (mmHg)
79 ± 16
89 ± 10
0.19
Characteristics of the ascitic fluid
Albumin (g/L)
7.7 ± 4.9
8.5 ± 2.1
0.74
Auto. polymorph count (cells × 109/L)
0.47 ± 1.89
4.76 ± 3.86
< 0.001
Manual polymorph count (cells × 106/L)
72 ± 259
1226 ± 1706
< 0.001
Table 5 Performance of automated and manual cell count methods in cohort 1, n (%)
Positive-SBP
Negative-SBP
Total
Manual method cell count
Test result
Positive
2 (40)
6
8
Negative
3
122 (95)
125
Total
5
128
133
Automated method cell count
Test result
Positive
4 (80)
21
25
Negative
1
111 (84)
112
Total
5
132
137
Table 6 Clinical and biochemical characteristics of positive-spontaneous bacterial peritonitis and negative-spontaneous bacterial peritonitis cases in cohort 2, n (%)/mean ± SD
Table 7 Markers of infection and characteristics of ascitic fluid in positive-spontaneous bacterial peritonitis and negative-spontaneous bacterial peritonitis cases in cohort 2, n (%)/mean ± SD
Negative-SBP (n = 52)
Positive-SBP (n = 33)
P value
Markers of inflammation
CRP (mg/L)
22 ± 17
57 ± 47
< 0.001
CRP > 5 mg/L
24 (89)
30 (91)
1.00
Leukocyte count in serum (× 109/L)
7.3 ± 2.1
11.1 ± 5.1
< 0.001
Neutrophil count in serum (× 109/L)
5.0 ± 1.8
8.6 ± 4.4
< 0.001
Temperature (°C)
36.9 ± 0.3
37.1 ± 1.0
0.22
Heart rate (beats per minute)
102 ± 16
104 ± 20
0.75
Respiratory rate (breaths per minute)
18 ± 3
21 ± 5
0.02
Presence of SIRS
4 (13)
14 (50)
0.004
MAP (mmHg)
84 ± 12
74 ± 17
0.01
Characteristics of the ascitic fluid
Albumin (g/L)
8.0 ± 4.1
7.5 ± 5.8
0.61
Automated polymorph count (cells × 109/L)
0.06 ± 0.06
3.27 ± 3.68
< 0.001
Manual polymorph count (cells × 106/L)
20 ± 22
2157 ± 4105
< 0.001
Table 8 Performance of automated and manual cell count methods in cohort 2, n (%)
Positive-SNP
Negative-SNP
Total
Manual method cell count
Test result
Positive
18 (58)
0
18
Negative
13
50 (100)
63
Total
31
50
81
Automated method cell count
Test result
Positive
21 (78)
2
23
Negative
6
49 (96)
55
Total
27
51
78
Table 9 Performance of automated and manual cell count methods in cases having both methods performed in cohort 2, n (%)
Automated method
Total
Positive
Negative
Positive-SBP cases
Manual method
Positive
13
0
13 (52)
Negative
7
5
12
Total
20 (80)
5
25
Negative-SBP cases
Manual method
Positive
0
0
0
Negative
2
47
49 (100)
Total
0
47 (96)
49
Table 10 Performance of automated and manual cell count methods, both with cutoff PMN ≥ 200 cells/mm3 in cases having both methods performed in cohort 2, n (%)
Automated method
Total
Positive
Negative
Positive-SBP cases
Manual method
Positive
14
0
14 (56)
Negative
6
5
11
Total
20 (80)
5
25
Negative-SBP cases
Manual method
Positive
0
0
0
Negative
2
47
49 (100)
Total
2
47 (96)
49
Table 11 Microbiological characteristics of positive-spontaneous bacterial peritonitis cases, n (%)
Positive-SBP (n = 33)
Origin of infection
Community-acquired
18 (55)
Healthcare-associated
11 (33)
Nosocomial
4 (12)
Cultures
Blood or urine culture taken
22 (67)
Blood or urine culture, same bacteria
8 (24)
Bacteria isolated
E. coli
18 (55)
Enterococcus faecium
8 (24)
Enterococcus faecalis
3 (9)
Klebsiella pneumoniae
1 (3)
S aureus
1 (3)
Streptococcus agalactie
1 (3)
Clostridium innocuum
1 (3)
Empirical antibiotic used
Piperacillin/tazobactam
15 (46)
meropenem
6 (18)
Levofloxacin
4 (12)
Co-amoxiclav
4 (12)
Teicoplanin
2 (6)
Tigecycline
1 (3)
Flucoxacillin
1 (3)
Citation: Acevedo-Haro JG, Mohamed W, Moodley P, Bendall O, Bennett K, Keelty N, Chan S, Waddy S, Hosking J, Thomas W, Tilley R. Sensitivity of diagnosis of spontaneous bacterial peritonitis is higher with the automated cell count method. World J Hepatol 2024; 16(11): 1265-1281