Spontaneous bacterial peritonitis: Difference between revisions
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+ | ==Background== |
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+ | *Primary infection of the ascitic fluid, diagnosed by ascites fluid with positive culture or with neutrophil count greater than 250 |
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+ | === Microbiology === |
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| + | ===Pathophysiology=== |
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| − | == Bacteriology == |
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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 |
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+ | ==Clinical Manifestations== |
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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%) |
| + | === Prognosis and Complications === |
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| − | == Investigations == |
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| − | * Labs |
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| − | ** Ascitic fluid for cell count and culture |
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| − | * Imaging |
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| − | * Other |
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| − | == |
+ | ==Investigations== |
| + | *Diagnostic paracentesis with ascitic fluid sent for cell count with differential and culture |
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| − | * Acute |
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| − | * Chronic |
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| − | == |
+ | ==Management== |
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| + | == Prevention == |
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[[Category:Intra-abdominal infections]] |
[[Category:Intra-abdominal infections]] |
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Revision as of 12:34, 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
- Escherichia coli (43%)
- Klebsiella pneumoniae (11%)
- Streptococcus pneumoniae (9%)
- Other streptococcal species (19%)
- Enterobacteriaceae (4%)
- Staphylococcus (3%)
- Pseudomonas (1%)
- Miscellaneous (10%)
- Aeromonas hydrophila, in Korea
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
- Ceftriaxone 1-2g IV q24h
Prevention
- Prophylaxis is indicated after even a single episode of SBP
- TMP-SMX SS PO daily
- Norfloxacin
- Possibly a role for primary prophylaxis
References
- ^ Ngoc Nguyen, Matthew Crotty, Edward A. Dominguez, Adil Habib, Hector E. Nazario, Zahid M. Vahora, Parvez S. Mantry, Jessiva Rago, Melanie Proffitt, Maisha N. Barnes, Ashwini Mehta, Mangesh R. Pagadala, Jeffrey S. Weinstein. Doxycycline for the prevention of spontaneous bacterial peritonitis. The Liver Meeting. 2023.
