Background: Spontaneous bacterial peritonitis (SBP) is one of the most common and feared complications associated with cirrhosis. Unlike variceal bleed or hepatic encephalopathy, SBP has an indolent course, leading to delayed diagnosis in most cases. The study aimed to determine factors associated with a delay in the diagnosis of SBP and its impact on the outcome of the disease. 

Methodology: This is a prospective study conducted in a tertiary care hospital in Kerala over a period of 1 year. The duration symptom onset to first hospital visit and treatment were studied, and patients were followed up until resolution of SBP. 

Results: 41 patients with SBP were recruited. The majority belonged to Child class C with a mean MELD score of 19.4. The mean (±SD) time gap between symptom onset and hospital visit was 48.6±43.5 hours. The mean (±SD) time gap between hospital visit and initiation of treatment for SBP was 51.1±20.3 hours. The mean duration between the onset of symptoms to treatment was 136.3±64.4 hours. The reasons for delayed presentation were unawareness(61%), family difficulties(48.8%), indifferent attitude to disease(12.2%) and financial problems(8%). Mortality was associated with poor response to antibiotic therapy, presence of complications like encephalopathy, hypotension, sepsis, and the time-gap between the onset of symptoms and treatment. 

Conclusion: The delay in diagnosing SBP and its treatment is associated with more frequent complications, including death. Unawareness of this complication in the community is the major cause of delay in seeking medical care, stressing the need for prompt education.