What is the indication for peritoneal fluid analysis in the workup of spontaneous bacterial peritonitis (SBP)?

Updated: Nov 26, 2018
  • Author: Thomas E Green, DO, MPH, MMM, CPE, FACEP, FACOEP; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Answer

Peritoneal fluid analysis must be performed in any patient in whom spontaneous bacterial peritonitis (SBP) is considered. In patients undergoing peritoneal dialysis (PD), this can be accomplished by obtaining a sample of the dialysate. In patients without a peritoneal catheter, diagnostic paracentesis must be performed.

The examination of ascitic fluid for SBP has routinely involved sending the fluid for cell count, differential, and culture. It has been accepted that the results of aerobic and anaerobic bacterial cultures, used in conjunction with the cell count, are beneficial in guiding therapy for those with SBP. [14]

Recent data, though, suggest that ascitic fluid cultures have generally been shown to be of low yield with respect to altering management of patients with ascites. In addition, positive culture and sensitivity results obtained from emergency department testing have not been shown to result in appropriate adjustment of antibiotic therapy by inpatient physicians. The reasons for this may include inpatient physicians' distrust of the culture results and the difficulty in determining what constitutes a true pathogen in ascitic fluid cultures. [15]

The sensitivity of microbiologic studies has been reported to increase significantly with the direct inoculation of routine blood culture bottles at the bedside with 10 mL of ascitic fluid.


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