Peritonite bacteriana espontânea

Abstract

Spontaneous bacterial peritonitis occurs in 30% of patients with ascites due to cirrhosis leading to high morbidity and mortality rates. The pathogenesis of spontaneous bacterial peritonitis is related to altered host defenses observed in end-stage liver disease, overgrowth of microorganisms, and bacterial translocation from the intestinal lumen to mesenteric lymph nodes. Clinical manifestations vary from severe to slight or absent, demanding analysis of the ascitic fluid. The diagnosis is confirmed by a number of neutrophils over 250/mm3 associated or not to bacterial growth in culture of an ascites sample. Enterobacteriae prevail and Escherichia coli has been the most frequent bacterium reported. Mortality rates decreased markedly in the last two decades due to early diagnosis and prompt antibiotic treatment. Third generation intravenous cephalosporins are effective in 70% to 95% of the cases. Recurrence of spontaneous bacterial peritonitis is common and can be prevented by the continuous use of oral norfloxacin. The development of bacterial resistance demands the search for new options in the prophylaxis of spontaneous bacterial peritonitis; probiotics are a promising new approach, but deserve further evaluation. Short-term antibiotic prophylaxis is recommended for patients with cirrhosis and ascites shortly after an acute episode of gastrointestinal bleeding.

MELD Score Is Not Related to Spontaneous Bacterial Peritonitis

“…SBP is associated with high mortality and the probability of long-term survival is 25–50% [ 6 ]. This infection has a poor prognosis [ 1 , 2 , 7 ] due to several severe complications, such as septic shock, progressive renal failure, variceal bleeding, and multiple organ failure [ 1 , 2 , 7 ].…”

“…Approximately two-thirds of SBP cases are asymptomatic [ 1 ]; thus the protocols of clinical practice set forth by the American Association for the Study of Liver Disease and EASL recommend performing analysis of ascites fluid for diagnosis of infection after each paracentesis procedure [ 7 ]. However, this approach is debatable and there are few studies that evaluate the analysis of ascitic fluid in asymptomatic patients [ 5 , 6 ].…”

Fasciite necrosante por Streptococcus agalactiae em paciente diabética - relato de caso

“…Por isso já existem diretrizes específicas para a pesquisa de rotina da bactéria na gestação e tratamento da parturiente portadora, visando à prevenção da infecção neonatal. 28,29 Já a ocorrência de FN por S. agalactiae é rara, mas adquire importância por sua letalidade.…”