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Spontaneous Bacterial Peritonitis

  • Ajay M. OhriEmail author
  • Indhu M. Subramanian
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Abstract

Spontaneous bacterial peritonitis (SBP) is a frequent and serious complication of ascites in the presence of advanced cirrhosis. Although SBP can be considered in other conditions associated with the presence of chronic ascites, SBP is most commonly associated with ascites from cirrhosis and its presence correlates with more advanced liver disease. SBP is defined as an ascitic fluid infection in the absence of a surgical etiology. Delay in recognition and appropriate treatment of peritoneal infections such as SBP can lead to sepsis and death. Symptoms include fever, abdominal pain, nausea and altered mental status although patients can be asymptomatic. Translocation of enteric bacteria from the gut into the peritoneal cavity accounts for the majority of SBP cases; however, other organisms, (fungal, mycobacteria, and more resistant nosocomial bacteria), can also be pathogenic and lead to peritonitis. The clinical diagnosis of SBP is suspected by the presence of ascites and compatible symptoms and is confirmed by ascitic fluid analysis showing elevated polymorphonuclear cells and a positive microbiologic culture. It is imperative to rule out secondary causes of peritonitis. Treatment primarily includes antibiotics and adjunctive albumin therapy in appropriate patients. Prophylaxis is a cornerstone of therapy for patients meeting criteria. Early identification and management of SBP has transformed this condition from one carrying a high mortality rate to a fairly well-managed and treated complication of chronic ascites in cirrhotic patients.

Keywords

Spontaneous bacterial peritonitis (SBP) Ascites Complicated cirrhosis SBP prophylaxis Albumin for SBP Fungal bacterial peritonitis Multi-resistant bacterial peritonitis Polymicrobial bacterascites Secondary bacterial peritonitis Abdominal compartment syndrome 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Internal MedicineHighland Hospital, Alameda Health SystemOaklandUSA
  2. 2.Pulmonary and Critical Care Faculty, Department of Internal MedicineHighland Hospital, Alameda Health SystemOaklandUSA

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