Epidemiology

Studies have demonstrated a SBP prevalence of 12% in patients with ascites admitted for decompensated cirrhosis, 18% in those admitted for hepatic encephalopathy, and 10% to 14% in those admitted with acute gastrointestinal hemorrhage.[4][5][6][7]​ Among asymptomatic patients receiving outpatient paracentesis, there is an approximately 2% prevalence.[8][9][10]​​ There are no data on sex or race prevalence of SBP beyond that which would be associated with ascites itself.

Although SBP may occur in the patient with ascites caused by malignancy, kidney failure, or congestive heart failure, it is a much less common occurrence than in patients with ascites due to end-stage liver disease.

Increased infections due to gram-positive cocci have been reported. Studies suggest that these changes are associated with long-term hospitalization of patients with end-stage liver disease and the use of prophylactic antibiotics with superior activity against gram-negative organisms after an initial episode of SBP.[11][12] However, gram-negative bacteria remain the most common pathogens in SBP.

Studies from different countries indicate that SBP pathogens isolated from ascitic fluid are increasingly resistant to antimicrobial therapy. One study found antibiotic resistance in SBP in North America to be 17.8%, with methicillin-resistant Staphylococcus aureus the most common resistant organism.[13]​ Resistance rates to cephalosporins and fluoroquinolones may be as high as 40%; 30% prevalence of extended spectrum beta-lactamases (ESBL) resistant Escherichia coli has been reported.[14][15]

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