Spontaneous bacterial peritonitis: A severe complication ofliver cirrhosis

Abstract

This report presents a survey of current knowledge concerning one of the relatively frequent and severe complications of liver cirrhosis and associated ascitesspontaneous bacterial peritonitis. Epidemiology, aetiology, pathogenesis, clinical manifestation, diagnosis and present possibilities of treatment are discussed.

Routine analysis of cirrhotic ascites for evidence of infection – not worth the effort?

“…The symptoms and mortality of patients with CNNA are similar to those of SBP. Further, 33% to 57% of patients with CNNA also showed a positive blood culture, providing evidence in support of presence of a systemic bacterial infection [12]. In contrast with CNNA, no standard treatment recommendations exist for MNB.…”

“…In patients with CNNA, other causes of PMN leukocytosis of ascitic fluid should be excluded (such as previous antibiotic therapy, hepatocellular carcinoma, peritoneal carcinomatosis, tuberculosis, pancreatitis and bleeding). This recommendation is based on the observation that about one-third of untreated cases with CNNA developed a positive ascitic fluid culture during follow up [12]. The symptoms and mortality of patients with CNNA are similar to those of SBP.…”

“…In contrast with CNNA, no standard treatment recommendations exist for MNB. It is believed that nearly 80% of cases with MNB do not progress to SBP [12]. In such cases, a repeat analysis of ascitic fluid 48 h later can safely rule out SBP.…”

Factors Predicting Failure of 3rd Generation Cephalosporins in Treatment of Spontaneous Bacterial Peritonitis- A Retrospective Observational Study

“…Small intestinal bacterial over growth, increased intestinal permeability, translocation of gut bacteria, decreased phagocytic activity of macrophages, deteriorated humoral immunity, decreased ascitic fluid opsonin activity will cause infections by gram neg enteric bacteria, of which SBP, UTI, pneumonia, cellulites are the most common (10,11) . It is well established that 30% to 50% of cirrhotic patients either have bacterial infections when admitted to a hospital or acquire them during this period, and such infections are responsible for up to 25% of deaths in this patient population.…”

Renal dysfunctions in cirrhosis

“…SBP should be investigated in all cirrhotic patients with ascites presenting with fever, abdominal pain, hepatic encephalopathy and AKI and early empiric antibiotic therapy should be instituted if SBP is present without waiting for the results of the ascites and blood cultures. Nephrotoxic drugs such as aminoglycosides should be avoided in patients with SBP as well (44)(45). Long term prophylactic antibiotic therapy is advised in patients with ascitic albumin concentration below 15 g/L to prevent recurrences (46).…”