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 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. However, caution must be used in antibiotic choice as changing resistance patterns have been demonstrated, including 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 likely require broader initial empiric coverage.
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 <1.5g/dL or a previous episode of SBP.
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.
Associate Professor of Emergency Medicine
UCSF Fresno Medical Education Program
BC is an author of a number of references cited in this monograph.
Hepatic Hemodynamic Laboratory
ADG declares that he has no competing interests.
Associate Professor of Medicine
Gastroenterology Fellowship Program
Medical College of Wisconsin
KS declares that he has no competing interests.
Assistant Professor of Medicine
Yale Viral Hepatitis Program
Section of Digestive Diseases
Yale School of Medicine
JKL declares that he has no competing interests.
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