Monomicrobial Nonneutrocytic Bacterascites: A Variant of Spontaneous Bacterial Peritonitis BRUCEA. RUNYON Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, 87131, and Liver Unit, University of Southern California School of Medicine, Los Angeles, California 90242
cells/mm3 and (c) there is no evident intraabdominal surgically treatable source for infection (1).Bacterascites is diagnosed when a single organism grows but the neutrophil count is < 250 ceUs/mm3(1).In comparison with the data base regarding SBP, little information is available regarding bacterascites. “Asymptomatic bacterascites” is mentioned in previous reports of series of patients with SBP (2-4). Only one study provides prospectively collected data regarding the prevalence of bacterascites; 18episodes were detected during the same interval that produced 27 episodes of SBP (4). However, the inclusion, in some of these series, of patients whose cultures showed only diphtheroids or Staphylococcus epidermidis from nonneutrocytic fluid raises the possibility of contamination of the cultures with skin flora (3, 4). In recent years I have substituted the modifier “monomicrobial~~for “asymptomatic” in describing bacterascites (a)because of the recognition that many of these patients are indeed symptomatic and (b) to distinguish this form of bacterascites from polymicrobial bacterascites, which is usually due to needle perforation of the bowel during attempted abdominal paracentesis (5). On the basis of the available literature, one cannot discern the frequency with which symptoms actually occur in patients with bacterial colonization of their ascitic fluid. Information regarding the importance of this variant of SBP and the natural history of colonization of ascites with pathogenic bacteria is not available. Also, the explanation of the lack of neutrophils in the ascitic fluid of these patients is not apparent. Is 715.) there a deficiency of chemoattractants in the fluid of Spontaneous bacterial peritonitis (SBP) is diagnosed these patients? Is monomicrobial bacterascites simply when (a) the ascitic fluid culture grows pathogenic early detected SBP before there is time for neutrophils bacteria (almost always pure growth of a single type of to enter the fluid or does this represent transient organism), (b) the ascitic fluid neutrophil count is 2 250 colonization of ascitic fluid with bacteria, analogous to the transient bacteremia that follows mastication? Does monomicrobial nonneutrocytic bacterascites (MNB) always require antimicrobial treatment? The purpose of this investigation was to attempt to provide answers to Received October 27, 1989; accepted May 7, 1990. This work was supported in part by grant 5-MOlRR00997-08 from the these questions.
Spontaneousbacterial peritonitis is diagnosed when (a) the ascitic fluid culture is positive, (b) the ascitic fluid neutrophil count is 2250 cells/mmsand (c) there!is no evident intraabdominalsurgically treatable source for infection. Few details are available regarding the variant of ascitic fluid infection in which the culture grows bacteria (pure growth of a single type of organism), but the neutrophil count is
cells/mm3 and (c) there is no evident intraabdominal surgically treatable source for infection (1).Bacterascites is diagnosed when a single organism grows but the neutrophil count is < 250 ceUs/mm3(1).In comparison with the data base regarding SBP, little information is available regarding bacterascites. “Asymptomatic bacterascites” is mentioned in previous reports of series of patients with SBP (2-4). Only one study provides prospectively collected data regarding the prevalence of bacterascites; 18episodes were detected during the same interval that produced 27 episodes of SBP (4). However, the inclusion, in some of these series, of patients whose cultures showed only diphtheroids or Staphylococcus epidermidis from nonneutrocytic fluid raises the possibility of contamination of the cultures with skin flora (3, 4). In recent years I have substituted the modifier “monomicrobial~~for “asymptomatic” in describing bacterascites (a)because of the recognition that many of these patients are indeed symptomatic and (b) to distinguish this form of bacterascites from polymicrobial bacterascites, which is usually due to needle perforation of the bowel during attempted abdominal paracentesis (5). On the basis of the available literature, one cannot discern the frequency with which symptoms actually occur in patients with bacterial colonization of their ascitic fluid. Information regarding the importance of this variant of SBP and the natural history of colonization of ascites with pathogenic bacteria is not available. Also, the explanation of the lack of neutrophils in the ascitic fluid of these patients is not apparent. Is 715.) there a deficiency of chemoattractants in the fluid of Spontaneous bacterial peritonitis (SBP) is diagnosed these patients? Is monomicrobial bacterascites simply when (a) the ascitic fluid culture grows pathogenic early detected SBP before there is time for neutrophils bacteria (almost always pure growth of a single type of to enter the fluid or does this represent transient organism), (b) the ascitic fluid neutrophil count is 2 250 colonization of ascitic fluid with bacteria, analogous to the transient bacteremia that follows mastication? Does monomicrobial nonneutrocytic bacterascites (MNB) always require antimicrobial treatment? The purpose of this investigation was to attempt to provide answers to Received October 27, 1989; accepted May 7, 1990. This work was supported in part by grant 5-MOlRR00997-08 from the these questions.
Spontaneousbacterial peritonitis is diagnosed when (a) the ascitic fluid culture is positive, (b) the ascitic fluid neutrophil count is 2250 cells/mmsand (c) there!is no evident intraabdominalsurgically treatable source for infection. Few details are available regarding the variant of ascitic fluid infection in which the culture grows bacteria (pure growth of a single type of organism), but the neutrophil count is
