الفهرس 
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Abstract
Background &purpose: Spontanous bacterial peritonitis (SBP) is a life threating complication of liver cirrhosis with ascites .The prevalence, risk factors and characteristics of these patients in Zagazig University Hospital Medical Intensive Care Unit (ICU) are lacking .We designed this study to identify the frequency, clinico -biochemical, microbial characteristics and short term outcome of patients with SBP in our Medical ICU. Patients &Methods: one hundred eighty nine patients admitted to medical ICU with significant ascites in association with liver cirrhosis –related emergencies were included in the study .All patients were subjected to thorough history taking, complete physical examination, routine biochemical and radiological investigations. Liver disease severity assessment with Child-Pugh and Model for End stage Liver Disease (MELD) scoring systems was calculated .Complete analysis of ascitic fluid specimens with culture and sensitivity testing according to standard methods was obtained prior to antibiotic administration. Results :One hundred six patients (56.1%) proved to have SBP with 50 (47.2%) as a classic variant (ascitic neutrophil cell count ≥ 250 cells\µl plus positive culture for bacteria) and 56 (52.8%) as culture negative neutrocytic ascites (CNNA) variants (ascitic neutrophil cell count ≥250 cells\µl plus negative culture for bacteria).Patients with history of prior use of beta blockers were at lower risk of having SBP(36.6% VS63.4%,P=0.004).Prior use of diuretics and hepatocellular carcinoma were encountered more in patients with CNNA compared to classic type of SBP .Short term mortality in ICU was higher in patients with SBP compared to patients without SBP (33.4% VS 30.8% respectively, p=0.024).No statistically significant difference regarding short term outcome in ICU between both variants of SBP. Using multiple regression analysis, increasing age and MELD score were found to be independent predictors of ICU mortality of patients with SBP .E.coli, Klebsiella and Staphylococcus aureus were the organisms isolated from ascitic fluids of patients with SBP (56% ,24% and 20% respectively).Conclusion: More than half of patients with ascites complicating liver cirrhosis in medical ICU have SBP. Prior use of beta blockers might be protective against, while hepatocellular carcinoma is a risk factor for SBP. Short term mortality in ICU is higher in patients with SBP, with increasing age and MELD score as independent predictors of mortality.