Spontaneous Bacterial Peritonitis

Spontaneous Bacterial Peritonitis is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Infection of ascites fluid without an evident intra-abdominal surgically treatable source:
    • Ascites fluid polymorphonuclear leukocyte count (PMN) >250/mL with a positive bacterial peritoneal fluid culture
  • Must be distinguished from secondary bacterial peritonitis:
    • 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

  • 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 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 infections outside of the gut
  • Usually seen in the setting of cirrhosis:
    • Rare in other conditions causing ascites (nephrotic syndrome or CHF)
  • Predominant organisms:
    • 63% aerobic gram-negative (Escherichia coli, Klebsiella, others)
    • 15% gram-positive (Streptococci)
    • 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

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TY - ELEC T1 - Spontaneous Bacterial Peritonitis ID - 307358 Y1 - 2016 PB - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307358/all/Spontaneous_Bacterial_Peritonitis ER -