LAUSR

of time). Of these samples, 28 were from subjects that had ascites secondary to liver cirrhosis, and 24 were from individuals with postoperative complications or peritoneal dialysis. Of the 28 samples from cirrhotic patients, which are further described below, 24 had a serum albumin-toascites gradient (SAAG) compatible with ascites from portal hypertension. All patients were males with a median age of 59 years (IQR 53–62) and median SAAG was 1.7 (IQR 1.3–2.2). The cause of cirrhosis was unknown in 12 cases (40%) and the most common known cause of cirrhosis was alcohol abuse (40%), followed by HCV (14%) and hemochromatosis (7%). Seven of the twenty-eight samples (25%) had >250 PMNs/mm compatible with SBP (median 400 cells/mm). None of the patients had fever on presentation, and only seven patients (25%) had abdominal pain. The presence of abdominal pain was not related to PMN content in ascitic fluid. Of 28 samples with positive growth in cirrhotic patients, 5 grew more than one organism. The most commonly identified organisms were coagulase negative Staphylococci (N:12) and Viridans streptococci (N:6), followed by Escherichia coli (N:4) and other Gram-negative organisms (Propionibacterium acnes, 4; Klebsiella sp, 2; Diphtheroids, S. anginosus, Acinetobacter, Stenotrophomonas, Veillonella, Bacteroides dorei, Prevotella bucae, Enterococcus Faecium, 1 each). Almost 40% of our samples grew coagulase negative Staphylococcus. We could not rule out that some of this growth is related to sample contamination. However, a bacterial flora of predominant Gram-positive cocci in both SBP and bacterascites was recently reported in a prospective observational French study by Piroth et al. in alignment with our findings [4]. Overall, our samples showed a lower number of Gram-negative bacteria than generally reported for SBP [4, 5]. This finding could be related to extraction technique, the veteran population, or difference in antibiotic use in the Veterans To the Editor,