To Compare the Efficacy of Carbepenem Versus Carbepenem Plus GM-CSF in Difficult To Treat Spontaneous Bacterial Peritonitis

Inclusion Criteria: 1. Age more than 18 years 2. Patients of decompensated liver cirrhosis who present with- Spontaneous bacterial peritonitis (Presence of more than 250 neutrophils per cc of ascetic fluid, in the absence of a surgical abdomen, in the presence of decompensated cirrhosis and portal hypertension) that is not responding to initial therapy- DTT-SBP: * Hospital acquired - New onset SBP (Spontaneous bacterial peritonitis) after 48 h of hospitalization. * Recurrent SBP - One or more prior episode(s) of SBP in year. * Antibiotic resistant - Resistance to 3rd Gen Cephalosporin in last 3 m. * Antibiotic non-response -Non-response to 3rd Gen Cephalosporin, sepsis on 3rd Gen Cephalosporin. Exclusion Criteria: 1. \< 18 years. 2. Advanced HCC (HepatoCellular Carcinoma) 3. Post liver transplant 4. HIV + ve, Immunosuppressive therapy 5. Pregnancy 6. Domiciliary treatment 7. No consent