Spontaneous bacterial peritonitis - Revision history

Aidan at 18:08, 19 September 2024

2024-09-19T18:08:26Z

← Older revision		Revision as of 18:08, 19 September 2024
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	**[[Norfloxacin]] 400 mg PO daily		**[[Norfloxacin]] 400 mg PO daily
	**[[Ciprofloxacin]] 500 mg PO daily		**[[Ciprofloxacin]] 500 mg PO daily
	**[[Doxycycline]] 100 mg PO daily is under investigations as an alternative~~<ref>Doxycycline~~ ~~for the prevention of spontaneous bacterial peritonitis. Abstract presented at the AASLD Liver Meeting 2020. Available at:~~ https://aasld.confex.com/aasld/2020/meetingapp.cgi/Paper/19190~~</ref>~~		**[[Doxycycline]] 100 mg PO daily is under investigations as an alternative[[CiteRef::nguyen2023do]] (see [https://aasld.confex.com/aasld/2020/meetingapp.cgi/Paper/19190 abstract])
	*Possibly a role for primary prophylaxis		*Possibly a role for primary prophylaxis

Aidan at 19:58, 1 December 2023

2023-12-01T19:58:18Z

← Older revision		Revision as of 19:58, 1 December 2023
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	**[[Norfloxacin]] 400 mg PO daily		**[[Norfloxacin]] 400 mg PO daily
	**[[Ciprofloxacin]] 500 mg PO daily		**[[Ciprofloxacin]] 500 mg PO daily
			**[[Doxycycline]] 100 mg PO daily is under investigations as an alternative<ref>Doxycycline for the prevention of spontaneous bacterial peritonitis. Abstract presented at the AASLD Liver Meeting 2020. Available at: https://aasld.confex.com/aasld/2020/meetingapp.cgi/Paper/19190</ref>
	*Possibly a role for primary prophylaxis		*Possibly a role for primary prophylaxis

Aidan: /* Prevention */

2020-08-26T00:30:03Z

Prevention

← Older revision		Revision as of 00:30, 26 August 2020
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	*Hypothermia (15%)		*Hypothermia (15%)

	=== Variants ===		===Variants===

	* '''Culture-negative neutrocytic ascites:''' usually caused by difficult-to-treat organisms like tuberculosis, and non-infective sources		*'''Culture-negative neutrocytic ascites:''' usually caused by difficult-to-treat organisms like tuberculosis, and non-infective sources
	* '''Monomicrobial non-neutrocytic bacterascites:''' early bacterial colonization		*'''Monomicrobial non-neutrocytic bacterascites:''' early bacterial colonization
	* '''Polymicrobial bacterascites:''' usually from traumatic paracentesis		*'''Polymicrobial bacterascites:''' usually from traumatic paracentesis

	===Prognosis and Complications===		===Prognosis and Complications===
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	==Management==		==Management==

	*[[Is treated by::Ceftriaxone]] 1-2g IV q24h		*[[Is treated by::Ceftriaxone]] 1-2g IV q24h + [[albumin]] 1.5 g/kg on day 1 and 1 g/kg on day 3

	==Prevention==		==Prevention==

	*Prophylaxis is indicated after even a single episode of SBP		*Prophylaxis is indicated after even a single episode of SBP
	**[[TMP-SMX]] SS PO daily		**[[TMP-SMX]] SS or DS PO daily
	**[[Norfloxacin]]		**[[Norfloxacin]] 400 mg PO daily
			**[[Ciprofloxacin]] 500 mg PO daily
	*Possibly a role for primary prophylaxis		*Possibly a role for primary prophylaxis

Aidan at 12:30, 24 August 2020

2020-08-24T12:30:49Z

← Older revision		Revision as of 12:30, 24 August 2020
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	*Primary infection of the ascitic fluid, diagnosed by ascites fluid with positive culture or with neutrophil count greater than 250		*Primary infection of the ascitic fluid, diagnosed by ascites fluid with positive culture or with neutrophil count greater than 250

	=== Microbiology ===		===Microbiology===

	*''[[Escherichia coli]]'' (43%)		*''[[Escherichia coli]]'' (43%)
	*''[[Klebsiella pneumoniae]]'' (11%)		*''[[Klebsiella pneumoniae]]'' (11%)
	*''[[Streptococcus pneumoniae]]'' (9%)		*''[[Streptococcus pneumoniae]]'' (9%), particularly affecting people with [[HIV]] and prepubertal girls
	*Other streptococcal species (19%)		*Other streptococcal species (19%)
	*Enterobacteriaceae (4%)		*Enterobacteriaceae (4%)
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	*Miscellaneous (10%)		*Miscellaneous (10%)
	**''[[Aeromonas hydrophila]]'', in Korea		**''[[Aeromonas hydrophila]]'', in Korea
			**[[Peritoneal tuberculosis]]
			**[[Dimorphic fungi]]

	===Pathophysiology===		===Pathophysiology===
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	*Hypothermia (15%)		*Hypothermia (15%)

	=== ~~Prognosis and Complications~~ ===		=== Variants ===

			* '''Culture-negative neutrocytic ascites:''' usually caused by difficult-to-treat organisms like tuberculosis, and non-infective sources
			* '''Monomicrobial non-neutrocytic bacterascites:''' early bacterial colonization
			* '''Polymicrobial bacterascites:''' usually from traumatic paracentesis

			===Prognosis and Complications===

	*In-hospital mortality of about 33% in hospital		*In-hospital mortality of about 33% in hospital
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	*[[Is treated by::Ceftriaxone]] 1-2g IV q24h		*[[Is treated by::Ceftriaxone]] 1-2g IV q24h

	== Prevention ==		==Prevention==

	*Prophylaxis is indicated after even a single episode of SBP		*Prophylaxis is indicated after even a single episode of SBP

Aidan at 17:34, 20 August 2020

2020-08-20T17:34:30Z

← Older revision		Revision as of 17:34, 20 August 2020
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	== ~~Definition~~ ==		==Background==

	* Primary infection of the ascitic fluid, diagnosed by ascites fluid with positive culture or with neutrophil count greater than 250		*Primary infection of the ascitic fluid, diagnosed by ascites fluid with positive culture or with neutrophil count greater than 250

	== ~~Pathophysiology~~ ==		=== Microbiology ===

		⚫	*''[[Escherichia coli]]'' (43%)
⚫	* Intestinal bacterial overgrowth with increased intestinal permeability leads to translocation to intestinal lymph notes and bloodstream, which results in hematogenous seeding to ascitic fluid
		⚫	*''[[Klebsiella pneumoniae]]'' (11%)
⚫	* Only occurs in portal hypertension, not in other causes of ascites
		⚫	*''[[Streptococcus pneumoniae]]'' (9%)
		⚫	*Other streptococcal species (19%)
		⚫	*Enterobacteriaceae (4%)
		⚫	*''[[Staphylococcus]]'' (3%)
		⚫	*''[[Pseudomonas]]'' (1%)
		⚫	*Miscellaneous (10%)
		⚫	**''[[Aeromonas hydrophila]]'', in Korea

			===Pathophysiology===
	== Bacteriology ==

		⚫	*Intestinal bacterial overgrowth with increased intestinal permeability leads to translocation to intestinal lymph notes and bloodstream, which results in hematogenous seeding to ascitic fluid
⚫	* ''[[Escherichia coli]]'' (43%)
		⚫	*Only occurs in portal hypertension, not in other causes of ascites
⚫	* ''[[Klebsiella pneumoniae]]'' (11%)
⚫	* ''[[Streptococcus pneumoniae]]'' (9%)
⚫	* Other streptococcal species (19%)
⚫	* Enterobacteriaceae (4%)
⚫	* ''[[Staphylococcus]]'' (3%)
⚫	* ''[[Pseudomonas]]'' (1%)
⚫	* Miscellaneous (10%)
⚫	** ''[[Aeromonas hydrophila]]'', in Korea

	== Risk Factors ==		===Risk Factors===

	* Previous history of SBP		*Previous history of SBP
	* Upper GI bleed		*[[Upper GI bleed]]
	* Low sciatic protein		*Low sciatic protein
	* Child-Pugh class		*Child-Pugh class

	== Clinical Manifestations ==		==Clinical Manifestations==

	* Asymptomatic in 10%		*Asymptomatic in 10%
	* Fever (70%)		*Fever (70%)
	* Abdominal pain (60%)		*Abdominal pain (60%)
	* Hepatic encephalopathy (50%)		*Hepatic encephalopathy (50%)
	* Abdominal tenderness, usually without rigidity (50%)		*Abdominal tenderness, usually without rigidity (50%)
	* Diarrhea (30%)		*Diarrhea (30%)
	* Ileus (30%)		*Ileus (30%)
	* Shock (20%)		*Shock (20%)
	* Hypothermia (15%)		*Hypothermia (15%)

			=== Prognosis and Complications ===
	== Investigations ==

		⚫	*In-hospital mortality of about 33% in hospital
	* Labs
		⚫	*58% 6-month mortality
	** Ascitic fluid for cell count and culture
⚫	*** Neutrophil count < 250 rules it out
⚫	*** Culture usually monomicrobial
⚫	** Repeat paracentesis at 48h if ongoing concern
	* Imaging
	* Other

	== ~~Management~~ ==		==Investigations==

			*Diagnostic paracentesis with ascitic fluid sent for cell count with differential and culture
	* Acute
		⚫	**Neutrophil count < 250 rules it out
⚫	** Ceftriaxone 1-2g IV q24h
		⚫	**Culture usually monomicrobial
	* Chronic
		⚫	*Repeat paracentesis at 48h if ongoing concern
⚫	** Prophylaxis after a single episode
⚫	*** Septra SS PO daily
⚫	*** Norfloxacin
⚫	* ~~Some~~ role for primary prophylaxis~~, I think?~~

	== ~~Prognosis~~ ==		==Management==

		⚫	*[[Is treated by::Ceftriaxone]] 1-2g IV q24h
⚫	* In-hospital mortality of about 33% in hospital

⚫	* 58% 6-month mortality
			== Prevention ==

		⚫	*Prophylaxis is indicated after even a single episode of SBP
		⚫	**[[TMP-SMX]] SS PO daily
		⚫	**[[Norfloxacin]]
		⚫	*Possibly a role for primary prophylaxis

	[[Category:Intra-abdominal infections]]		[[Category:Intra-abdominal infections]]

Aidan: Text replacement - "== Presentation" to "== Clinical Manifestations"

2020-08-02T12:07:29Z

Text replacement - "== Presentation" to "== Clinical Manifestations"

← Older revision		Revision as of 12:07, 2 August 2020
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	* Child-Pugh class		* Child-Pugh class

	== ~~Presentation~~ ==		== Clinical Manifestations ==

	* Asymptomatic in 10%		* Asymptomatic in 10%

Aidan: /* Bacteriology */

2019-08-17T15:28:15Z

Bacteriology

← Older revision		Revision as of 15:28, 17 August 2019
Line 10:		Line 10:
	== Bacteriology ==		== Bacteriology ==

	* ''Escherichia coli'' (43%)		* ''[[Escherichia coli]]'' (43%)
	* ''Klebsiella pneumoniae'' (11%)		* ''[[Klebsiella pneumoniae]]'' (11%)
	* ''Streptococcus pneumoniae'' (9%)		* ''[[Streptococcus pneumoniae]]'' (9%)
	* Other streptococcal species (19%)		* Other streptococcal species (19%)
	* Enterobacteriaceae (4%)		* Enterobacteriaceae (4%)
	* ''Staphylococcus'' (3%)		* ''[[Staphylococcus]]'' (3%)
	* ''Pseudomonas'' (1%)		* ''[[Pseudomonas]]'' (1%)
	* Miscellaneous (10%)		* Miscellaneous (10%)
	** ''Aeromonas hydrophila'', in ~~Korean~~		** ''[[Aeromonas hydrophila]]'', in Korea

	== Risk Factors ==		== Risk Factors ==

Aidan at 15:27, 17 August 2019

2019-08-17T15:27:22Z

← Older revision		Revision as of 15:27, 17 August 2019
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	= Definition =		== Definition ==

	* Primary infection of the ascitic fluid		* Primary infection of the ascitic fluid, diagnosed by ascites fluid with positive culture or with neutrophil count greater than 250

	= Pathophysiology =		== Pathophysiology ==

	* Intestinal bacterial overgrowth with increased intestinal permeability leads to translocation to intestinal lymph notes and bloodstream, which results in hematogenous seeding to ascitic fluid		* Intestinal bacterial overgrowth with increased intestinal permeability leads to translocation to intestinal lymph notes and bloodstream, which results in hematogenous seeding to ascitic fluid
	* Only occurs in portal hypertension, not in other causes of ascites		* Only occurs in portal hypertension, not in other causes of ascites

	= Bacteriology =		== Bacteriology ==

	* ''Escherichia coli'' (43%)		* ''Escherichia coli'' (43%)
Line 20:		Line 20:
	** ''Aeromonas hydrophila'', in Korean		** ''Aeromonas hydrophila'', in Korean

	= Risk Factors =		== Risk Factors ==

	* Previous history of SBP		* Previous history of SBP
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	* Child-Pugh class		* Child-Pugh class

	= Presentation =		== Presentation ==

	* Asymptomatic in 10%		* Asymptomatic in 10%
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	* Hypothermia (15%)		* Hypothermia (15%)

	= Investigations =		== Investigations ==

	* Labs		* Labs
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	* Other		* Other

	= Management =		== Management ==

	* Acute		* Acute
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	* Some role for primary prophylaxis, I think?		* Some role for primary prophylaxis, I think?

	= Prognosis =		== Prognosis ==

	* In-hospital mortality of about 33% in hospital		* In-hospital mortality of about 33% in hospital

Aidan: /* Spontaneous bacterial peritonitis (SBP) */

2019-08-15T01:33:46Z

Spontaneous bacterial peritonitis (SBP)

← Older revision		Revision as of 01:33, 15 August 2019
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	= Spontaneous bacterial peritonitis (SBP) =

	= Definition =		= Definition =

Aidan at 01:33, 15 August 2019

2019-08-15T01:33:40Z

← Older revision		Revision as of 01:33, 15 August 2019
Line 1:		Line 1:
	= Spontaneous bacterial peritonitis (SBP) =		= Spontaneous bacterial peritonitis (SBP) =

	== Definition ==		= Definition =

	* Primary infection of the ascitic fluid		* Primary infection of the ascitic fluid

	== Pathophysiology ==		= Pathophysiology =

	* Intestinal bacterial overgrowth with increased intestinal permeability leads to translocation to intestinal lymph notes and bloodstream, which results in hematogenous seeding to ascitic fluid		* Intestinal bacterial overgrowth with increased intestinal permeability leads to translocation to intestinal lymph notes and bloodstream, which results in hematogenous seeding to ascitic fluid
	* Only occurs in portal hypertension, not in other causes of ascites		* Only occurs in portal hypertension, not in other causes of ascites

	== Bacteriology ==		= Bacteriology =

	* ''Escherichia coli'' (43%)		* ''Escherichia coli'' (43%)
Line 22:		Line 22:
	** ''Aeromonas hydrophila'', in Korean		** ''Aeromonas hydrophila'', in Korean

	== Risk Factors ==		= Risk Factors =

	* Previous history of SBP		* Previous history of SBP
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	* Child-Pugh class		* Child-Pugh class

	== Presentation ==		= Presentation =

	* Asymptomatic in 10%		* Asymptomatic in 10%
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	* Hypothermia (15%)		* Hypothermia (15%)

	== Investigations ==		= Investigations =

	* Labs		* Labs
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	* Other		* Other

	== Management ==		= Management =

	* Acute		* Acute
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	* Some role for primary prophylaxis, I think?		* Some role for primary prophylaxis, I think?

	== Prognosis ==		= Prognosis =

	* In-hospital mortality of about 33% in hospital		* In-hospital mortality of about 33% in hospital
	* 58% 6-month mortality		* 58% 6-month mortality

			[[Category:Intra-abdominal infections]]
	== Further Reading ==