Jan 20, 2020 this is a core content post on spontaneous bacterial peritonitis sbp, which is an acute infection of the ascitic fluid in a patient with liver disease without another source of infection. Spontaneous bacterial peritonitis, an infection of ascitic fluid, occurs in the absence of perforation of a hollow viscus or an intraabdominal inflammatory focus such as an abscess, acute pancreatitis, or cholecystitis. Sbp is the most common infection causing renal impairment in cirrhotics 2, 3. A common complication in patients with spontaneous bacterial peritonitis and a high score in the model for endstage liver disease. Management of spontaneous bacterial peritonitis 1 empirical antibiotic therapy. Prophylaxis based on selective intestinal decontamination sid with oral antibiotics such as quinolones and trimethoprim. The etiology of sbp is infection of the ascitic fluid. Spontaneous bacterial peritonitis sbp is defined as an ascitic fluid. In patients with cirrhosis and ascites, longterm use of norfloxacin or trimethoprim sulfamethasoxazole can be justified if the ascitic fluid protein 2012.
Kk spontaneous bacterial peritonitis is an infection that occurs in ascites, fluid in the abdomen that may develop in patients with cirrhosis. If your patient has liver cirrhosis, alcohol excess or alcoholic liver disease and clinical ascites or shifting dullness or a fluid thrill present sbp should be suspected. Peritonitis is a generic term defined as inflammation of the peritoneal lining. Spontaneous bacterial peritonitis caused by listeria. Defined as an ascitic fluid infection, it can be lifethreatening to patients with or without proper treatment. The causes of peritonitis can be grouped into five categories.
Outcomes in patients with spontaneous bacterial peritonitis are poor since acute kidney injury, acuteonchronic liver failure, and death occur in. Spontaneous bacterial peritonitis rebel em emergency. It is distinguished from secondary peritonitis by the absence of an evident intraabdominal surgically treatable source. Dec 12, 2006 spontaneous bacterial peritonitis sbp is the infection of ascitic fluid in the absence of any intra. Spontaneous bacterial peritonitis by brucella in a. It tends to occur most commonly in patients with cirrhosis, and the condition can radically complicate the liver condition, leading to severe problems for the patient. Antimicrobial treatment and prophylaxis of spontaneous bacterial peritonitis diagnosis spontaneous bacterial peritonitis sbp is a frequent and serious complication of cirrhotic patients with ascites. Are proton pump inhibitors a threat for spontaneous bacterial peritonitis and hepatic encephalopathy in cirrhosis. Spontaneous bacterial peritonitis in patients with.
Spontaneous bacterial peritonitis symptoms, diagnosis and. Santa catarina, ufsc, between september 2009 and march 2012. Generally, no source of the infecting agent is easily identifiable, but contamination of dialysate can cause the condition among those receiving peritoneal dialysis pd. Evaluation of albumin in spontaneous bacterial peritonitis background spontaneous bacterial peritonitis sbp is among one of the major complications of cirrhotic liver disease. Computed tomographic scanning should also be performed. More than 92% of all cases of sbp are monomicrobial. Spontaneous bacterial peritonitis sbp is an infection which occurs in some patients with ascites, a condition in which fluid accumulates in the abdomen.
Spontaneous bacterial peritonitis cancer therapy advisor. The presence of sbp, which almost always occurs in patients with cirrhosis and ascites, is suspected because of signs and symptoms such as fever, abdominal pain, or altered mental status table 1. Spontaneous bacterial peritonitis sbp is one of the most common causes of. Infectious peritonitis is subdivided into spontaneous or primary bacterial peritonitis, secondary peritonitis, peritoneal dialysisassociated peritonitis, and tertiary perito. Spontaneous bacterial peritonitissbp is defined as the infection of ascitic fluid without any apparent intra abdominal focus of infection in patients of cirrhosis of liver6,7.
Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. Peritonitis in nephrotic syndrome patients pediatric focus. Pdf spontaneous bacterial peritonitis researchgate. S,md pg in gastroenterology, amckgh slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Spontaneous bacterial peritonitis by brucella in a cirrhotic. Acute infection of the ascitic fluid in a patient with liver disease without another source of infection epidemiology runyon 1988, runyon 1988, borzio 2001. Unusual presentation of more common diseaseinjury cirrhosis.
Are proton pump inhibitors a threat for spontaneous. Spontaneous bacterial peritonitis symptoms, diagnosis. Spontaneous bacterial peritonitis sbp is defined as an ascitic fluid infection without an evident intraabdominal surgically treatable source 1. To assess the risk of development of spontaneous bacterial peritonitis in relation to the ascitic fluid total protein concentration, routine admission abdominal paracentesis was performed on a. Causes of peritonitis the two main types of peritonitis are primary spontaneous peritonitis, an infection that develops in the peritoneum. In young children presenting with abdominal pain, clinicians must examine thoroughly to exclude peripheral oedema, routinely perform urinalysis to exclude heavy proteinuria and consider nephrotic syndrome as the primary diagnosis. Spontaneous bacterial peritonitis sbp is a severe and often fatal infection in patients with cirrhosis and ascites. Management of adult patients with ascites due to cirrhosis. The following is a list of these categories and some examples of their causes.
Spontaneous bacterial peritonitis sbp is the development of a bacterial infection in the peritoneum, despite the absence of an obvious source for the infection. Spontaneous bacterial peritonitis sbp is a serious complication that occurs among cirrhotic patients. Oct 05, 2014 spontaneous bacterial peritonitis sbp is the development of peritonitis infection in the abdominal cavity despite the absence of an obvious source for the infection. Shortcourse versus longcourse antibiotic treatment of spontaneous bacterial peritonitis. Recognition and management of spontaneous bacterial peritonitis this is a pdf version of the following document. Evaluation of albumin in spontaneous bacterial peritonitis. Effect of intravenous albumin on endotoxin removal, cytokines, and nitric oxide production in patients with cirrhosis and spontaneous bacterial. Management of adult patients with ascites due to cirrhosis aasld. Spontaneous bacterial peritonitis sbp is an infection of ascites that occurs in the absence of an identified intra. Spontaneous bacterial peritonitis caused by listeria monocytogenes. Spontaneous bacterial peritonitis sbp clinical presentation. Spontaneous bacterial peritonitis sbp is the most common infection with a high morbidity and mortality, occurring in 10% to 30% of cirrhotic patients with ascites, and associated with a very high rate of recurrence. Brucella is known to be a possible, but exceedingly rare, causative agent of sbp.
Diagnosis of spontaneous bacterial peritonitis indications for testing in a patient with ascites, the presence of newonset fever temperature greater than 37. Spontaneous bacterial peritonitis sbp is defined as bacterial infections that occur in patients with cirrhosis and ascites without any significant intraperitoneal infection, accounting for. Microrna155 is upregulated in ascites in patients with spontaneous bacterial peritonitis skip to main content thank you for visiting. It is specifically an infection of the ascitic fluid an increased volume of peritoneal fluid. In patients with cirrhosis and ascites, longterm use of norfloxacin or trimethoprim sulfamethasoxazole can be justified if the ascitic fluid protein spontaneous bacterial peritonitis sbp is defined as an ascitic fluid infection without an evident intraabdominal surgically treatable source 1. Spontaneous peritonitis critical care a severe acute infection of the peritoneum that accompanies endstage liver disease and ascites agents e coli, klebsiella spp, s pneumoniae, enterococcus faecalis clinical abdominal pain, ascites, chills, encephalopathy, fever, rebound tenderness lab ascitic fluid has. Spontaneous bacterial peritonitis sbp is defined as the infection of ascitic fluid without any apparent intra abdominal focus of infection in patients of cirrhosis of liver6,7. Spontaneous bacterial peritonitis sbp is an acute bacterial infection of ascitic fluid. Microrna155 is upregulated in ascites in patients with. Randomized, comparative study of oral ofloxacin versus intravenous cefotaxime in. Spontaneous bacterial peritonitis sbp is a common and potentially fatal infection of ascitic fluid in patients with cirrhosis. Spontaneous bacterial peritonitis sbp is a frequent and serious complication of ascites in the presence of advanced cirrhosis. Guadalupe garciatsao, in goldmans cecil medicine twenty fourth edition, 2012. Recent advances in clinical practice spontaneous bacterial.
Ascitic paracentesis remains the chief diagnostic procedure. Acute infection of the ascitic fluid in a patient with liver disease without another source of infection. The colon contains a large number of bacteria, more than the number of cells in the entire human body. Spontaneous bacterial peritonitis pubmed central pmc. Causative agents and outcome of spontaneous bacterial peritonitis. Core concepts recognition and management of spontaneous. Ascites is most commonly a complication of cirrhosis of the liver. The prevalence of sbp is 1030% in hospitalized patients with cirrhosis and ascites.
Spontaneous bacterial peritonitis is the most frequent bacterial infection in patients with cirrhosis. Management of nosocomial spontaneous bacterial peritonitis. Dosing of ceftriaxone for spontaneous bacterial peritonitis. Spontaneous bacterial peritonitis guidelines authors.
Ability to continue until resolution of ascites, liver transplantation, or death. The presence of sbp, which almost always occurs in patients with cirrhosis and ascites, is suspected because of suggestive signs and symptoms, such as fever, abdominal pain, or altered mental. Safety and efficacy of rifaximin in prophylaxis of. The confirmed diagnosis of spontaneous bacterial peritonitis requires an ascitic fluid absolute polymorphonuclear leukocyte pmn count of at least 250 cellsmm 3 0. Antimicrobial treatment and prophylaxis of spontaneous. Spontaneous bacterial peritonitis as a presenting feature of nephrotic syndrome. Spontaneous bacterial peritonitis with sepsis caused by.
Pdf on oct 1, 1998, j such and others published spontaneous bacterial peritonitis find, read and cite all the research you need on. It is one of the most frequently encountered bacterial infections in patients with cirrhosis. Defined as an ascitic fluid infection, it can be lifethreatening to patients. Spontaneous bacterial peritonitis sbp is an infection of ascitic fluid that cannot be attributed to any intraabdominal, ongoing inflammatory, or surgically correctable condition. A retrospective study was performed on 334 patients with culturepositive sbp at beijing youan hospital, china, between january 2012. Spontaneous bacterial peritonitis in patients with cirrhosis. Shortterm prophylaxis indicated in setting of variceal bleeding. Spontaneous bacterial peritonitis sbp is the most frequent and lifethreatening infection in patients with liver cirrhosis requiring prompt recognition and treatment. The diagnosis is distinct from secondary peritonitis and hence is made in the absence of an intraabdominal source of infection or in.
Sponaneo baceemia and ponaneo baceial peionii in cihoi. Clinical and laboratorial features of spontaneous bacterial peritonitis. The aim of this metaanalysis was to evaluate the role of rifaximin in the prevention of sbp. Spontaneous bacterial peritonitis etiology bmj best practice. Spontaneous bacterial peritonitis sbp is associated with ascites from patients with cirrhosis highest risk patients for sbp, heart failure, or patients with systemic lupus and nephrosis. Indications for spontaneous bacterial peritonitis prophylaxis.
The role of rifaximin in the prevention of spontaneous bacterial peritonitis sbp is not well studied. Recognition and management of spontaneous bacterial. Despite timely diagnosis and treatment its reported incidence in ascitic patients varies between 730%. However, the incidence and outcome of renal dysfunction have not been particularly. Jan 11, 2017 microrna155 is upregulated in ascites in patients with spontaneous bacterial peritonitis skip to main content thank you for visiting. Spontaneous bacterial peritonitis sbp is a serious complication of cirrhosis with a death rate of 1015%. Nov 26, 2018 spontaneous bacterial peritonitis sbp is an acute bacterial infection of ascitic fluid.
Bacterial translocation, or the migration of bacteria. The reported incidence varies between 7% and 30% in hospitalized patients with cirrhosis and ascites, representing one of their main complications. 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. The usual causative agents 90% of sbp are enteric gramnegative bacteria escherichia coli and klebsiella pneumoniae. Spontaneous bacterial peritonitis sbp is a common and frequently fatal bacterial infection of ascites occurring in patients with cirrhosis who have diverse symptomatology. Spontaneous bacterial peritonitis sbp is a frequent form of decompensation of endstage liver disease, with an incidence of 1520% and a shortterm mortality of 1033%. Spontaneous bacterial peritonitis etiology bmj best.
We report a case of a 47yearold man with cirrhosis. Update on spontaneous bacterial peritonitis scielo colombia. Spontaneous bacterial peritonitis sbp is one of the most common causes of infection in decompensated cirrhosis, and recommen. Outcomes in patients with spontaneous bacterial peritonitis are poor since acute kidney injury. Spontaneous bacterial peritonitis is a common complication in patients of cirrhosis of liver8. Bacterial infections are a significant cause of morbidity and mortality in patients with cirrhosis. It is defined by the presence of 250 polymorphonuclear cells pmnmm3 in ascites in the absence of an intraabdominal source of infection or malignancy. Spontaneous bacterial peritonitis sbp is a frequent and serious complication of cirrhotic patients with ascites.
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