Spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis (SBP) is one of the most frequently encountered bacterial infections in patients with cirrhosis, and most commonly seen in patients with end-stage liver disease.

Key symptoms are abdominal pain, fever, vomiting, altered mental status, and gastrointestinal (GI) bleeding. However, patients are commonly minimally symptomatic, and may even be asymptomatic.

Ascitic fluid laboratory tests should include cell count and culture.

SBP is diagnosed by an ascitic fluid absolute neutrophil count >250 cells/mm³, in the absence of an intra-abdominal surgically treatable source of infection. Positive blood cultures confirm the diagnosis.

Treatment is directed primarily at early administration of appropriate empirical antibiotic regimens. The practitioner must be aware of local resistance patterns, with particular reference to increased third-generation cephalosporin and fluoroquinolone resistance.

Patients with sepsis, history of fluoroquinolone prophylaxis, nosocomial-acquired SBP, or a history of previous infections with resistant organisms are likely to require broader initial empirical coverage.

Albumin is indicated in the treatment of patients with SBP; particularly for those with kidney dysfunction.

Continuous antibiotic prophylaxis is indicated in patients with a previous episode of SBP, upper GI bleeding, or in patients with an ascitic fluid protein concentration <15g/L (<1.5 g/dL) plus evidence of severe liver failure (Child-Pugh score >9 points with serum bilirubin >51.31 micromol/L [>3 mg/dL]) and/or renal dysfunction (serum creatinine >106 micromol/L [>1.2 mg/dL], urea >8.92 mmol/L [>25 mg/dL], or serum sodium <130 mmol/L [<130 mEq/L]).

Spontaneous bacterial peritonitis (SBP) is an infection of ascitic fluid that cannot be attributed to any intra-abdominal, ongoing inflammatory, or surgically correctable condition. It is one of the most frequently encountered bacterial infections in patients with cirrhosis.