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"lnfected ascites is one of the complication happened in liver cirrhotic patient in ascites. There are 5 infected ascites classifications i. e. Spontaneous Ascites Infection Consist of Spontaneous Bacterial Peritonitis, Monomicrobial Non Neurocytic Bacteriascites, Culture Negative Neurovytic Ascites, Secondary Bacterial Peritonitis and Iantrogenic Polimicrobial Bacterascites. Spontaneous Bacterial Peritonitis (SBP) is the infection in ascites without unrecognized intra abdominal infection source. The normal floras in the gastrointestinal, respiratory or urinal tract are the important infection source in SBP. As we know that normal ascites has ability to kill micro organism through phagocitosis function, opsonization, but when infected occurs; phagocitosis function, opsanization, and MPS could be worst so that the possibility of being SBP increased. The commoon frequently sign and symtom of SBP are fever, abdominal pain, consciousness assault,tenderness, diarrhea, paralytic ileus, hypotension and hypothermia. Some of the invasive actions like endoscopy, variceal sclerothrerapy and ligation may cause intestine flora translocation to mesenteric gland bacterimia and infected ascites also made transmural passage intestine micro organism to ascites may cause infected ascites. Cefotaxime is the antibiotic that more frequently studied to SBP patient. The close of cefotaxirne to SBP patient show that 2 grant/6 hours and 2 grain/I2 hours injected produce SBP resolution and the same survival, besides that 2 gram/8 hours injected for 5 and 10 days also show the same effectively. The antibiotic prophylaxis such as quinolon group show the effective result in liver cirrhotic with the gastroentestinal tract bleeding and lout total protein (<1 graim/dl ) or has the SBP experience patients."

"Spontaneous bacterial peritonitis (SBP) is one of serious complication of liver cirrhosis. Most of the patient with SBP have severe reduced liver function that clasified as Child Plugh class C. There are other risk factors for SBP such as poor nutritional status, GI bleeding, intravascular catheter insertion, ascites fluid protein concentration of less than I g/L, large volume paracentesis, urinary tract infection and respiratory tract infection. The management of SBP is mainly the administration of proper antibiotics. The antibiotic of choice for the emperial treatment is cefotaxim."

"Spontaneous Bacterial Peritonitis (SBP) adalah salah satu komplikasi yang sering terjadi pada pasien sirosis hepatis. Tiga populasi pasien yang berisiko tinggi terinfeksi SBP adalah pasien dengan perdarahan gastrointestinal bagian atas, pasien dengan kadar protein rendah dalam cairan asites, dan pasien yang memiliki riwayat episode SBP sebelumnya. Antibiotik sefalosporin merupakan terapi empiris awal yang dapat digunakan untuk penanganan SBP. Penelitian ini bertujuan untuk menganalisis secara deskriptif efektivitas dan biaya antibiotik sefalosporin yang digunakan pada pasien sirosis hepatis dengan risiko Spontaneous Bacterial Peritonitis. Desain penelitian ini adalah non eksperimental dengan desain studi perbandingan dan pengambilan data secara retrospektif menggunakan data sekunder dari rekam medis dan tagihan biaya pasien di RSUP Fatmawati. Pengambilan sampel secara total sampling. Sampel yang diikutkan dalam penelitian berjumlah 12 pasien, yaitu 9 pasien dengan sefotaksim dan 3 pasien dengan seftriakson. Efektivitas sefotaksim sebesar 8 hari, sedangkan efektivitas seftriakson adalah sebesar 9 hari. Total biaya medis langsung sefotaksim adalah sebesar Rp 4.695.577,00, sedangkan pada seftriakson adalah sebesar Rp 5.181.533,00.

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Spontaneous Bacterial Peritonitis (SBP) is one of the complications that often occur in patients with liver cirrhosis. Three high risk infected patient populations are patients with upper gastrointestinal bleeding, patients with low levels of protein in the ascites fluid, and patients who had a history of previous episodes of SBP. Cephalosporin is the the initial empirical therapy that could be used for SBP treatment. This study aimed to analyze descriptively the effectiveness and cost cephalosporin used in liver cirrhosis patients with Spontaneous Bacterial Peritonitis risk.

Design of this study was non-experimental with comparative studies and retrospective data collection which was using secondary data from medical records and patient bills in Fatmawati Hospital. Samples were taken by using total sampling method. Samples were included in the study amounted to 12 patients, 9 patients with cefotaxime and 3 patients with ceftriaxone. Effectiveness of cefotaxime was 8 days, while the effectiveness of ceftriaxone was 9 days. The total direct medical cost of cefotaxime was Rp 4,695,577.00, while ceftriaxone was Rp 5,181,533.00."

"LATAR BELAKANG : Sirosis hati merupakan salah satu masalah kesehatan di Indonesia. Penyakit ini merupakan penyakit hati yang sering dijumpai selain hepatitis virus akut dan kanker hati. Komplikasi sirosis hati yang tersering adalah asites. Adanya asites merupakan prognosis yang buruk karena hanya sekitar 50% penderita sirosis hati dengan asites dapat bertahan hidup dalarn waktu 2 tahun. Asites juga merupakan faktor predisposisi terjadinya komplikasi berbahaya seperti Peritonitis Bakteri Spontan (PBS).BAHAN DAN METODE : 74 subyek penelitian penderita sirosis hati dengan asites. Pada cairan asites dilakukan biakan aerob-anaerob, pemeriksaan hitung leukosit dengan alat hitung sel otomatis Sysmex XT2000i®, hitung jenis leukosit dengan mikroskop dan uji leukosit esterase carik celup urin sedangkan pemeriksaan albumin, protein dan LDH dilakukan untuk serum dan cairan asites.HASIL : Pada penelitian ini didapatkan penderita PBS sebanyak 14 orang (18.92%). Pada kelompok PBS didapatkan netrositik asites sebanyak 12 orang (85.71%). Dari hasil biakan yang positif pads kelompok penderita PBS berhasil diisolasi dua jenis kuman golongan Enterobacteriaceae yaitu Escherichia call dan Enterobacter aerogenes. Kedua kuman ini diduga menghasilkan Extended Spectrum Beta Lactamase (ESBL). Dengan menggunakan cara perhitungan stastistik menurut Bland-Altman didapatkan bahwa hasil hitung jumlah leukosit pada cairan asites dengan menggunakan alat otomatis Sysmex XT2000P tidak berbeda bermakna dengan cara manual. Untuk memperkirakan jumlah PMN cairan asites ? 250 sellpL maka cut off point untuk MuitistixlOSG® adaiah pada skala trace sedangkan untuk Comburl4M® adalah pada skala positif-2. Sebagian besar cairan asites pada penderita PBS termasuk transudat berdasarkan kriteria Light (85.71 %). Pada 92.86 % penderita PBS mempunyai SAAG > 1.1 g/dL.KESIMPULAN : Pada penelitian ini diperoleh proporsi PBS sebesar 18.92 % dan proporsi netrositik asites sebesar 85.71%. Kedua jenis kuman batang Gram negatif diduga menghasilkan ESBL sehingga resisten terhadap Sefotaksim. Hitung leukosit cairan asites dapat dilakukan dengan alat penghitung sel otomatis Sysmex XT2000i. Leukosit esterase carik celup urin Multistixi OSG® dan Comburl0M@ dapat digunakan untuk memperkirakan jumlah PMN cairan asites > 250 sellpL. Cairan asites pada penderita PBS temasuk transudat menurut modifikasi kriteria Light. PBS tidak mempengaruhi SAAG.SARAN : Parasentesis diagnostik harus dilakukan sebelum pemberian antibiotik empirik. Leukosit esterase carik celup urin dapat digunakan sebagai salah satu cara untuk memdiagnosis PBS secara "bedside". Penelitian lanjutan untuk mendapatkan pola dan kepekaan antibiotika kuman penyebab PBS.

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Cirrhosis is identified as one of major health problems in Indonesia. It is found to be the most prevalent liver disease in addition to acute viral hepatitis and liver cancer. Ascites is the most common complication associated with cirrhosis. About 50% of patients with cirrhosis who develop ascites die within 2 years of diagnosis. Ascites also predisposes life-threatening complication such as Spontaneous Bacterial Peritonitis (SBP).

Materials and Methods. 74 cirrhosis patients who develop ascites were included in the study. The ascitic fluid was cultured in aerobic and anaerobic media. Leukocytes were evaluated for leukocytes count using Sysmex XT2000iT"" automatic cell counter, leukocytes differential count was observed under the microscope, and dip stick urine of leukocyte esterase test. Moreover, albumin, protein, and LDH level were assessed for both serum and ascitic fluid.

Results. Spontaneous Bacterial Peritonitis was diagnosed in 14 subjects (18.92%). Twelve subjects (85.71%) within this group developed neutrocytic ascites. Enterobacteriaceae pathogens, i.e. Eschericiiia coil and Enterobacter aerogerles, had been isolated from the ascitic fluid culture. These pathogens were suspected for producing Extended Spectrum Beta Lactamase (ESBL). Using Bland-Altman test, it was discovered that there were no significant differences in leukocytes count of ascitic fluid either measured with Sysmex XT2000iT"' automatic cell counter or conventional method. The cut-off point for MultistixlOSGTm was set on trace scale, whereas the ComburlOMTM was set on scale positive-2 to obtain a number of PMN leukocytes count of more than 250 cellslpL. Based on Light criteria, 85.71% of ascitic fluid from the SBP patients were considered as transudates. Meanwhile, 92.86% of SBP group showed an SHAG ? 1.lg/dL.

Conclusions. The study reveals that the proportion of SBP is 18.92% and neutrocytic ascites is 85.71%. Both of the Gram-negative bacteria are considered producing ESBL that induce resistance to Cefotaxime. Leukocytes count of ascitic fluid can be measured using Sysmex XT2000iTM automatic cell counter. To predict PMN leukocyte count of more than 250 cells/pL, the dip stick urine leukocytes esterase test using MultistixlOSGT"^ and ComburlOMTM are available. The ascitic fluid in SBP patients are classified as transudates, based on Light criteria. SBP has no effect against SAAG.

Suggestions. A diagnostic paracentesis should be performed prior to empirical antibiotics therapy. The dip stick urine leukocytes esterase test can be use as an alternative method to diagnose SBP along with the other bedside techniques. Further study is required to attain pattern and sensitivity of SBP pathogens."

"[Salah satu komplikasi berat akibat kolestasis kronik adalah peritonitis bakteri spontan (PBS). Kondisi ini dapat meningkatkan angka mortalitas pada anak dengan kolestasis. Penelitian ini bertujuan untuk mengetahui faktor risiko dan spektrum klinis PBS pada anak dengan kolestasis di RSCM. Penelitian ini dilakukan pada bulan Agustus sampai Oktober 2015 dengan metode kohort retrospektif terhadap pasien anak dengan kolestasis usia 0-5 tahun yang diikuti selama 6 bulan melalui rekam medis pasien. Dari 97 pasien, didapatkan prevalensi PBS sebanyak 13,4%. Dari analisis multivariat didapatkan rasio odds untuk sirosis sebesar 10,21 (IK 95%=1,83-56,84). Manifestasi klinis yang sering ditemukan adalah infeksi di tempat lain (n=12, 92,3%), sirosis (n=11, 84,6%), hepatomegali (n=9, 69,2%), splenomegali (n=8, 61,5%), dan perdarahan saluran cerna (n=8, 61,5%). Mikroorganisme patogen dari hasil kultur cairan asites adalah Streptococcus epidermidis (n=1) dan Klebsiella pneumoniae(n=1). Sirosis merupakan faktor risiko independen terhadap kejadian PBS pada anak dengan kolestasis, Spontaneous bacterial peritonitis (SBP) is a serious complication of chronic cholestasis. This condition may increase mortality rate among the children with cholestasis. The aim of this research is to identify risk factors and clinical spectrums of SBP in children with cholestasis admitted to RSCM. This research was conducted from August to October 2015 by using retrospective cohort study toward cholestatic children age 0-5 years old who were followed-up for 6 months through medical record. From 97 patients, prevalence of SBP is 13.4%. In multivariate analysis, odds ratio for cirrhosis is 10.21 (95% CI=1.83-56.84). The most common clinical manifestations in children with SBP are other source of infections (n=12, 92.3%), cirrhosis (n=11, 84.6%), hepatomegaly (n=9, 69.2%), splenomegaly (n=8, 61.5%), and gastrointestinal bleeding (n=8, 61.5%). Microorganism pathogens from ascitic fluid cultures are Streptococcus epidermidis (n=1) and Klebsiella pneumoniae (n=1). Cirrhosis is an independent risk factor of SBP in children with cholestasis.]"

"Patients with liver cirrhosis frequently have infection which can deteriorate further the already impaired liver function. The most common form of infection in this particular patients are spontaneous bacterial peritonitis, urinary tract infection, and respiratory infection. Causative organism mostly Gram negative micro organism and originate from the gastrointestinal tract. The weaken of immune defense mechanism and also the altered gastrointestinal tract motility can explained most of these infection. This paper will review the bacterial infection in liver cirrhosis with some guidance in the management."