Spontaneous Bacterial Peritonitis
Basics
Description
Description
- Infection of ascitic fluid without an evident intra-abdominal surgically treatable source:
- Ascitic fluid polymorphonuclear leukocyte count (PMN) >250/mL with a positive bacterial peritoneal fluid culture
- Must be distinguished from secondary bacterial peritonitis (from an intra-abdominal visceral infection):
- Nonsurgical management of secondary bacterial peritonitis carries 100% mortality
- Surgical management of spontaneous bacterial peritonitis (SBP) carries 80% mortality
- Up to 30% yearly incidence of SBP in patients with ascites
Etiology
Etiology
- Mechanism:
- Portal hypertension causes translocation of intestinal bacteria through edematous gut mucosa to the peritoneal cavity
- Variceal bleeding increases the risk of SBP due to a compromised barrier between the gastrointestinal (GI) tract and blood stream
- Transient bacteremia with low serum complement
- Decreased host defense mechanisms
- Impaired activity of reticuloendothelial system phagocytosis and opsonization
- Can also seed ascitic fluid via bacteremia from extra-abdominal infections
- Usually seen in the setting of cirrhosis:
- Rare in other conditions causing ascites (e.g., nephrotic syndrome, CHF)
- Predominant organisms:
- 63% aerobic gram-negative (Escherichia coli, Klebsiella, others)
- 15% gram-positive (Streptococci/Staphylococci)
- 6–10% enterococci
- <1% anaerobic
- Gram-positives account for 50% of cases in patients who are on prophylactic therapy with fluoroquinolones
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Citation
Schaider, Jeffrey J., et al., editors. "Spontaneous Bacterial Peritonitis." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307358/1.3/Spontaneous_Bacterial_Peritonitis.
Spontaneous Bacterial Peritonitis. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307358/1.3/Spontaneous_Bacterial_Peritonitis. Accessed October 5, 2024.
Spontaneous Bacterial Peritonitis. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307358/1.3/Spontaneous_Bacterial_Peritonitis
Spontaneous Bacterial Peritonitis [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 October 05]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307358/1.3/Spontaneous_Bacterial_Peritonitis.
* Article titles in AMA citation format should be in sentence-case
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