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Spontaneous Bacterial Peritonitis

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

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  • 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


  • 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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Rosen, Peter, et al., editors. "Spontaneous Bacterial Peritonitis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307358/all/Spontaneous_Bacterial_Peritonitis.
Spontaneous Bacterial Peritonitis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307358/all/Spontaneous_Bacterial_Peritonitis. Accessed April 25, 2019.
Spontaneous Bacterial Peritonitis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307358/all/Spontaneous_Bacterial_Peritonitis
Spontaneous Bacterial Peritonitis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307358/all/Spontaneous_Bacterial_Peritonitis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Spontaneous Bacterial Peritonitis ID - 307358 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307358/all/Spontaneous_Bacterial_Peritonitis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -