Spontaneous Bacterial Peritonitis

Abstract

Spontaneous bacterial peritonitis (SBP) is a frequent and serious complication of ascites in the presence of advanced cirrhosis. Although SBP can be considered in other conditions associated with the presence of chronic ascites, SBP is most commonly associated with ascites from cirrhosis and its presence correlates with more advanced liver disease (Runyon, Management of adult patient with ascites due to cirrhosis: update 2012. The American Association for the Study of Liver Diseases. AASLD Practice Guideline, 1–87, 2013; Such and Runyon, Clin Infect Dis 27:669–674, 1998). SBP is defined as an ascitic fluid infection in the absence of a surgical etiology. Delay in recognition and appropriate treatment of peritoneal infections such as SBP can lead to sepsis and death. Symptoms include fever, abdominal pain, nausea and altered mental status although patients can be asymptomatic (Runyon, Hepatology 12:710–715, 1990). Translocation of enteric bacteria from the gut into the peritoneal cavity accounts for the majority of SBP cases (Moore and Van Thiel, World J Hepatol 5:251–263, 2013); however, other organisms, (fungal, mycobacteria, and more resistant nosocomial bacteria), can also be pathogenic and lead to peritonitis. The clinical diagnosis of SBP is suspected by the presence of ascites and compatible symptoms and is confirmed by ascitic fluid analysis showing elevated polymorphonuclear cells and a positive microbiologic culture. It is imperative to rule out secondary causes of peritonitis. Treatment primarily includes antibiotics and adjunctive albumin therapy in appropriate patients. Prophylaxis is a cornerstone of therapy for patients meeting criteria. Early identification and management of SBP has transformed this condition from one carrying a high mortality rate to a fairly well managed and treated complication of chronic ascites in cirrhotic patients.