Despite the widespread use of broad spectrum antibiotics, bacterial infection is responsible for up to a quarter of the deaths of patients with liver disease.'The occurrence of bacterial infection in patients with different types of liver disease is difficult to ascertain from published reports, but the most susceptible seem to be those with alcoholic cirrhosis, especially when complicated by gastrointestinal haemorrhage. Ina recent review of 187 patients admitted to hospital with alcoholic cirrhosis bacterial infection was present in 46% of cases, half of which were serious.'In a four year follow up study of 37 patients with alcoholic cirrhosis the same authors found one or more episodes of bacterial infection in 38% of cases whichproved fatal in nearly a third. In contrast, patients with chronic active hepatitis or primary biliary cirrhosis do not appear to be so susceptible to infection."Bacterial infection is extremely uncommon in patients with acute viral hepatitis or drug induced liver disease but may be responsible for up to 20% of deaths in the few cases which progress to fulminant hepatic failure or subacute hepatic necrosis.'-" Infection can prove fatal either directly or by precipitation of encephalopathy, gastrointestinal haemorrhage, or renal failure. Often recognition of infection is made more difficult by the absence of the normal clinical feature of infection-that is, fever, rigors, hypotension, and leucocytosis, in which case the only clues may be deterioration of hepatic precoma or coma or renal function.'6