Spontaneous bacterial peritonitis: Difference between revisions

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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]]

Revision as of 17:34, 20 August 2020

Background

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

Microbiology

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%)

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

Prevention

  • Prophylaxis is indicated after even a single episode of SBP
  • Possibly a role for primary prophylaxis