Summary

• 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 GI bleeding. However, patients are commonly minimally symptomatic, and may even be asymptomatic.
• Ascitic fluid laboratory tests should include cell count and culture. Bedside leukocyte esterase reagent strip testing can more rapidly rule in spontaneous bacterial peritonitis (SBP) but cannot rule it out.
• Defined by an ascitic fluid absolute neutrophil count >250 cells/mm^3, whether or not there is culture growth.
• Empiric antibiotic regimens that have been found to be equally efficacious include cefotaxime, ceftriaxone, fluoroquinolones, and ampicillin/sulbactam.
• Albumin is indicated in the treatment of patients with renal dysfunction.
• Continuous oral fluoroquinolone prophylaxis is indicated in patients with an ascitic fluid protein concentration <15g/L (<1.5g/dL) or a previous episode of SBP.