SHM Converge Scientific Abstract ePoster Gallery-A Variant of Spontaneous Bacterial Peritonitis

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This case highlights bacterascites, defined as ascitic fluid with a PMN count below 250 cells/mm³ but a positive culture, in contrast to spontaneous bacterial peritonitis (SBP), which has a PMN count of 250 or higher. Although bacterascites is often considered asymptomatic, it may carry a prognosis similar to SBP and can be associated with mortality higher than predicted by MELD score.<br /><br />The patient was a 64-year-old woman with decompensated alcoholic cirrhosis who was admitted for acute cholecystitis and initially treated with piperacillin-tazobactam. Over the hospital course, she underwent multiple paracenteses. Early taps showed low PMN counts and negative cultures. Later, after worsening abdominal symptoms and encephalopathy, a repeat paracentesis eventually grew vancomycin-resistant Enterococcus faecium, while the PMN count remained below the SBP threshold at that time. She was treated with antibiotics, but her condition later deteriorated with aspiration pneumonia, acute renal failure, ICU admission, intubation, vasopressor support, and transition to comfort care.<br /><br />The authors emphasize that bacterascites should not be dismissed as benign. Early repeat paracentesis is important to determine whether the condition is progressing to SBP or whether a culture result is a contaminant. A rising PMN count should prompt immediate antibiotic treatment. More research is needed to clarify when repeat paracentesis and antibiotics are indicated in bacterascites.

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Jay H. Park

Meta Tag

Author List Jay H. Park, Marissa Oshiro, Matthew Coster, Qiuchen Jiang, Rita Poon

Category Clinical Vignettes

Concept Bacterascites

Concept Spontaneous Bacterial Peritonitis

Concept Ascitic Fluid PMN Count

Concept Peritoneal Fluid Culture

Concept Diagnostic Paracentesis

Distinguished Non-Finalist

Presenter Organization Medstar Georgetown University Hospital

Presenting Author Jay H. Park

Track Adult

Keywords

bacterascites

spontaneous bacterial peritonitis

ascitic fluid

PMN count

cirrhosis

paracentesis

Enterococcus faecium

vancomycin-resistant Enterococcus

repeat paracentesis

antibiotic treatment

Bacterascites

Spontaneous Bacterial Peritonitis

Ascitic Fluid PMN Count

Peritoneal Fluid Culture

Diagnostic Paracentesis