Spontaneous bacterial peritonitis: How to deal with this life-threatening cirrhosis complication?

Abstract

Spontaneous bacterial peritonitis (SBP) is one of the most common and life-threatening complications of cirrhosis. It occurs in 10% to 30% of patients admitted to hospital and recent studies tend to demonstrate that SBP incidence seems to be decreasing in its frequency. A bacterial overgrowth with translocation through the increased permeable small intestinal wall and impaired defense mechanisms is considered to be the main mechanism associated with its occurrence. The Gram-negative aerobic bacteria are the major responsible for SBP episodes and Gram-positive bacteria, mainly Staphylococcus aureus, are being considered an emergent agent causing SBP. The prompt diagnosis of SBP is the key factor for reduction observed in mortality rates in recent years. The clinical diagnosis of SBP is neither sensitive nor specifi c and the search for new practical and available tools for a rapid diagnosis of SBP is an important endpoint of current studies. Reagent strips were considered a promising and faster way of SBP diagnosis. The prompt use of empirical antibiotics, mostly cefotaxime, improves signifi cantly the short-term prognosis of cirrhotic patients with SBP. The recurrence rate of SBP is high and antibiotic prophylaxis has been recommended in high-risk settings. Unfortunately, the long-term prognosis remains poor.

Nosocomial and Community-Acquired Spontaneous Bacterial Peritonitis in patients with liver cirrhosis in China: Comparative Microbiology and Therapeutic Implications

“…Spontaneous bacterial peritonitis (SBP) is a common complication in cirrhotic patients with ascites12, Patients with ascites who have been followed prospectively for one year have a 10% to 25% incidence of having at least one episode of SBP during that time period3. Because of an improved understanding of SBP, an earlier detection of infection, and a larger application of safe and effective antibiotics from which to choose, infection-related mortality resulting from SBP has markedly decreased45.…”

“…Many studies have investigated the treatment efficacy of various antibiotics on SBP and found that the therapeutic consequences were related to the source of SBP infection10. Patients with nosocomial SBP exhibited a greater resistance to antibiotics than those with community-acquired SBP13.…”

Effect of gastric acid suppressants and prokinetics on peritoneal dialysis-related peritonitis

“…Data on acid suppressive therapy with proton pump inhibitors (PPIs), histamine-2 receptor blockers (H2Bs), and other antacids were recorded separately. Ribeiro et al [18] reported that PPI use 48 h after the first dose increases and sustains gastric acid suppression. In addition, a single dose of PPI per day may cause protopathic bias.…”

Spontaneous Bacterial Peritonitis: Is It Still A Life-Threatening Issue in Cirrhosis?

“…abdominal pain, encephalopathy or renal dysfunction) or who have been admitted in a hospital for some reason should be considered at potential risk of SBP. Encephalopathy is the most common feature related to SBP, followed by abdominal pain and fever [47,48] . In such cases, patients must undergo diagnostic paracentesis.…”