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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 - 199 - 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 - 200 - (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. |