Abstract
Spontaneous bacterial peritonitis (SBP) is defined as an infection of ascites fluid, typically in the setting of bacterial gut translocation in patients with cirrhosis and ascites, and without another explanation for peritonitis. SBP is a major source of morbidity and mortality among patients with cirrhosis and requires a high clinical suspicion by the treating practitioner followed by diagnostic paracentesis and prompt initiation of antibiotics to prevent complications. This chapter reviews the pathogenesis and precipitating risk factors leading to the development of SBP, followed by a discussion of clinical presentation and diagnostic evaluation for patients suspected of having SBP. The remainder of the chapter focuses on treatment principles for an acute episode of SBP as well as strategies and guidelines for patients at high risk of SBP who may benefit from prophylaxis.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Conn HO. Spontaneous peritonitis and bacteremia in Laennec’s cirrhosis caused by enteric organisms: a relatively common but rarely recognized syndrome. Ann Intern Med. 1964;60(4):568–80.
Garcia-Tsao G. Current management of the complications of cirrhosis and portal hypertension: variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Gastroenterology. 2001;120(3):726–48.
McHutchison JG, Runyon BA. Spontaneous bacterial peritonitis. In: Surawicz CM, Owen RL, editors. Gastrointestinal and hepatic infections. Philadelphia, PA: WB Saunders Company; 1994.
Chang C-S et al. Small intestine dysmotility and bacterial overgrowth in cirrhotic patients with spontaneous bacterial peritonitis. Hepatology. 1998;28(5):1187–90.
Bauer TM et al. Small intestinal bacterial overgrowth in patients with cirrhosis: prevalence and relation with spontaneous bacterial peritonitis. Am J Gastroenterol. 2001;96(10):2962–7.
Cirera I et al. Bacterial translocation of enteric organisms in patients with cirrhosis. J Hepatol. 2001;34(1):32–7.
Caly WR, Strauss E. A prospective study of bacterial infections in patients with cirrhosis. J Hepatol. 1993;18(3):353–8.
Obstein KL et al. Association between model for end-stage liver disease and spontaneous bacterial peritonitis. Am J Gastroenterol. 2007;102(12):2732–6.
Bajaj JS et al. Association of proton pump inhibitor therapy with spontaneous bacterial peritonitis in cirrhotic patients with ascites. Am J Gastroenterol. 2009;104(5):1130–4.
Terg R et al. Proton pump inhibitor therapy does not increase the incidence of spontaneous bacterial peritonitis in cirrhosis: a multicenter prospective study. J Hepatol. 2015;62:1056.
Runyon BA. Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis. Gastroenterology. 1986;91(6):1343–6.
Titó L et al. Recurrence of spontaneous bacterial peritonitis in cirrhosis: frequency and predictive factors. Hepatology. 1988;8(1):27–31.
Rimola A et al. Oral, nonabsorbable antibiotics prevent infection in cirrhotics with gastrointestinal hemorrhage. Hepatology. 1985;5(3):463–7.
Bernard B et al. Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology. 1999;29(6):1655–61.
Fernández J et al. Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. Gastroenterology. 2007;133(3):818–24.
Senkerikova R et al. Genetic variation in TNFA predicts protection from severe bacterial infections in patients with end-stage liver disease awaiting liver transplantation. J Hepatol. 2014;60(4):773–81.
Such J et al. Low C 3 in cirrhotic ascites predisposes to spontaneous bacterial peritonitis. J Hepatol. 1988;6(1):80–4.
Bonnel AR, Bunchorntavakul C, Rajender Reddy K. Immune dysfunction and infections in patients with cirrhosis. Clin Gastroenterol Hepatol. 2011;9(9):727–38.
Woolf GM, Runyon BA. Spontaneous Salmonella infection of high-protein noncirrhotic ascites. J Clin Gastroenterol. 1990;12(4):430–2.
Thuluvath PJ, Morss S, Thompson R. Spontaneous bacterial peritonitis—in-hospital mortality, predictors of survival, and health care costs from 1988 to 1998. Am J Gastroenterol. 2001;96(4):1232–6.
Orman ES et al. Paracentesis is associated with reduced mortality in patients hospitalized with cirrhosis and ascites. Clin Gastroenterol Hepatol. 2014;12(3):496–503.
Grabau CM et al. Performance standards for therapeutic abdominal paracentesis. Hepatology. 2004;40(2):484–8.
Kim JJ et al. Delayed paracentesis is associated with increased in-hospital mortality in patients with spontaneous bacterial peritonitis. Am J Gastroenterol. 2014;109(9):1436–42.
De A, Bankar S, Baveja S. Comparison of three culture methods for diagnosis of Spontaneous Bacterial Peritonitis (SBP) in adult patients with cirrhosis. Int J Curr Microbiol Appl Sci. 2014;3(7):156–60.
Runyon BA et al. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. Ann Intern Med. 1992;117(3):215–20.
Chavez-Tapia NC, et al. Antibiotics for spontaneous bacterial peritonitis in cirrhotic patients. Cochrane Database Syst Rev 2009; (1): CD002232.
Felisart J et al. Cefotaxime is more effective than is ampicillin-tobramycin in cirrhotics with severe infections. Hepatology. 1985;5(3):457–62.
Runyon BA et al. Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis. A randomized controlled study of 100 patients. Gastroenterology. 1991;100(6):1737–42.
Follo A et al. Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis. Hepatology. 1994;20(6):1495–501.
Tandon P, Garcia-Tsao G. Renal dysfunction is the most important independent predictor of mortality in cirrhotic patients with spontaneous bacterial peritonitis. Clin Gastroenterol Hepatol. 2011;9(3):260–5.
Ruiz-del-Arbol L et al. Systemic, renal, and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis. Hepatology. 2003;38(5):1210–8.
Sort P et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med. 1999;341(6):403–9.
Salerno F, Navickis RJ, Wilkes MM. Albumin infusion improves outcomes of patients with spontaneous bacterial peritonitis: a meta-analysis of randomized trials. Clin Gastroenterol Hepatol. 2013;11(2):123–30.
Mandorfer M et al. Nonselective β blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis. Gastroenterology. 2014;146(7):1680–90.
Ginés P et al. Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: results of a double-blind, placebo-controlled trial. Hepatology. 1990;12(4):716–24.
Soriano G et al. Selective intestinal decontamination prevents spontaneous bacterial peritonitis. Gastroenterology. 1991;100(2):477–81.
Singh N et al. Trimethoprim-sulfamethoxazole for the prevention of spontaneous bacterial peritonitis in cirrhosis: a randomized trial. Ann Intern Med. 1995;122(8):595–8.
Rolachon A et al. Ciprofloxacin and long-term prevention of spontaneous bacterial peritonitis: results of a prospective controlled trial. Hepatology. 1995;22(4):1171–4.
Chavez-Tapia NC, et al. Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding. Cochrane Database Syst Rev 2010; (9): CD002907.
Carbonell N et al. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology. 2004;40(3):652–9.
Khashab MA et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc. 2015;81(1):81.
Minuk GY et al. Daily ciprofloxacin treatment for patients with advanced liver disease awaiting liver transplantation reduces hospitalizations. Dig Dis Sci. 2011;56(4):1235–41.
Rolando N et al. Infectious sequelae after endoscopic sclerotherapy of oesophageal varices: role of antibiotic prophylaxis. J Hepatol. 1993;18(3):290–4.
Dellinger RP et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39(2):165–228.
Su D-H et al. Value of serum procalcitonin levels in predicting spontaneous bacterial peritonitis. Hepatogastroenterology. 2013;60(124):641–6.
Parsi MA et al. Ascitic fluid lactoferrin for diagnosis of spontaneous bacterial peritonitis. Gastroenterology. 2008;135(3):803–7.
Mendler MH et al. A new highly sensitive point of care screen for spontaneous bacterial peritonitis using the leukocyte esterase method. J Hepatol. 2010;53(3):477–83.
Hanouneh MA et al. The role of rifaximin in the primary prophylaxis of spontaneous bacterial peritonitis in patients with liver cirrhosis. J Clin Gastroenterol. 2012;46(8):709–15.
Lutz P et al. Impact of rifaximin on the frequency and characteristics of spontaneous bacterial peritonitis in patients with liver cirrhosis and ascites. PLoS One. 2014;9(4):e93909.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Schiro, A.J. (2017). Spontaneous Bacterial Peritonitis (SBP). In: Saeian, K., Shaker, R. (eds) Liver Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-30103-7_31
Download citation
DOI: https://doi.org/10.1007/978-3-319-30103-7_31
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-30101-3
Online ISBN: 978-3-319-30103-7
eBook Packages: MedicineMedicine (R0)