Spontaneous bacterial peritonitis: Difference between revisions
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| + | ==Background== |
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| − | = Definition = |
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+ | *Primary infection of the ascitic fluid, diagnosed by ascites fluid with positive culture or with neutrophil count greater than 250 |
| + | ===Microbiology=== |
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| + | *''[[Streptococcus pneumoniae]]'' (9%), particularly affecting people with [[HIV]] and prepubertal girls |
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| + | **[[Peritoneal tuberculosis]] |
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| + | **[[Dimorphic fungi]] |
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| − | = Bacteriology = |
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| − | * ''Streptococcus pneumoniae'' (9%) |
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+ | ===Risk Factors=== |
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+ | *Previous history of SBP |
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+ | *[[Upper GI bleed]] |
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+ | *Low sciatic protein |
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+ | *Child-Pugh class |
| + | ==Clinical Manifestations== |
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| − | = Presentation = |
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+ | *Asymptomatic in 10% |
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+ | *Fever (70%) |
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+ | *Abdominal pain (60%) |
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+ | *Hepatic encephalopathy (50%) |
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+ | *Abdominal tenderness, usually without rigidity (50%) |
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+ | *Diarrhea (30%) |
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+ | *Ileus (30%) |
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+ | *Shock (20%) |
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+ | *Hypothermia (15%) |
| + | ===Variants=== |
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| + | *'''Culture-negative neutrocytic ascites:''' usually caused by difficult-to-treat organisms like tuberculosis, and non-infective sources |
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| − | * Labs |
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| + | *'''Monomicrobial non-neutrocytic bacterascites:''' early bacterial colonization |
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| − | ** Ascitic fluid for cell count and culture |
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| + | *'''Polymicrobial bacterascites:''' usually from traumatic paracentesis |
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| − | * Imaging |
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| − | * Other |
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| + | ===Prognosis and Complications=== |
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| − | * Acute |
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| − | ** Ceftriaxone 1-2g IV q24h |
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| − | * Chronic |
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| − | *** Norfloxacin |
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| − | = Prognosis = |
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| + | *Diagnostic paracentesis with ascitic fluid sent for cell count with differential and culture |
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| + | *[[Is treated by::Ceftriaxone]] 1-2g IV q24h + [[albumin]] 1.5 g/kg on day 1 and 1 g/kg on day 3 |
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| + | ==Prevention== |
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| + | **[[Norfloxacin]] 400 mg PO daily |
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| + | **[[Ciprofloxacin]] 500 mg PO daily |
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| + | **[[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> |
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[[Category:Intra-abdominal infections]] |
[[Category:Intra-abdominal infections]] |
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Latest revision as of 15:58, 1 December 2023
Background
- Primary infection of the ascitic fluid, diagnosed by ascites fluid with positive culture or with neutrophil count greater than 250
Microbiology
- Escherichia coli (43%)
- Klebsiella pneumoniae (11%)
- Streptococcus pneumoniae (9%), particularly affecting people with HIV and prepubertal girls
- Other streptococcal species (19%)
- Enterobacteriaceae (4%)
- Staphylococcus (3%)
- Pseudomonas (1%)
- Miscellaneous (10%)
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
- Only occurs in portal hypertension, not in other causes of ascites
Risk Factors
- Previous history of SBP
- Upper GI bleed
- Low sciatic protein
- Child-Pugh class
Clinical Manifestations
- Asymptomatic in 10%
- Fever (70%)
- Abdominal pain (60%)
- Hepatic encephalopathy (50%)
- Abdominal tenderness, usually without rigidity (50%)
- Diarrhea (30%)
- Ileus (30%)
- Shock (20%)
- Hypothermia (15%)
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
- 58% 6-month mortality
Investigations
- Diagnostic paracentesis with ascitic fluid sent for cell count with differential and culture
- Neutrophil count < 250 rules it out
- Culture usually monomicrobial
- Repeat paracentesis at 48h if ongoing concern
Management
- Ceftriaxone 1-2g IV q24h + albumin 1.5 g/kg on day 1 and 1 g/kg on day 3
Prevention
- Prophylaxis is indicated after even a single episode of SBP
- TMP-SMX SS or DS PO daily
- Norfloxacin 400 mg PO daily
- Ciprofloxacin 500 mg PO daily
- Doxycycline 100 mg PO daily is under investigations as an alternative[1]
- Possibly a role for primary prophylaxis
- ↑ 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
