Spontaneous bacterial peritonitis: Difference between revisions
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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 |
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===Microbiology=== |
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*''[[Escherichia coli]]'' (43%) |
*''[[Escherichia coli]]'' (43%) |
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*''[[Klebsiella pneumoniae]]'' (11%) |
*''[[Klebsiella pneumoniae]]'' (11%) |
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*''[[Streptococcus pneumoniae]]'' (9%) |
*''[[Streptococcus pneumoniae]]'' (9%), particularly affecting people with [[HIV]] and prepubertal girls |
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*Other streptococcal species (19%) |
*Other streptococcal species (19%) |
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*Enterobacteriaceae (4%) |
*Enterobacteriaceae (4%) |
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*Miscellaneous (10%) |
*Miscellaneous (10%) |
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**''[[Aeromonas hydrophila]]'', in Korea |
**''[[Aeromonas hydrophila]]'', in Korea |
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**[[Peritoneal tuberculosis]] |
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**[[Dimorphic fungi]] |
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===Pathophysiology=== |
===Pathophysiology=== |
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*Hypothermia (15%) |
*Hypothermia (15%) |
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=== 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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* '''Monomicrobial non-neutrocytic bacterascites:''' early bacterial colonization |
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* '''Polymicrobial bacterascites:''' usually from traumatic paracentesis |
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===Prognosis and Complications=== |
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*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 |
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== |
==Prevention== |
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*Prophylaxis is indicated after even a single episode of SBP |
*Prophylaxis is indicated after even a single episode of SBP |
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Revision as of 12:30, 24 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%), 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
Prevention
- Prophylaxis is indicated after even a single episode of SBP
- TMP-SMX SS PO daily
- Norfloxacin
- Possibly a role for primary prophylaxis
