Spontaneous peritonitis in critically ill cirrhotic patients: a diagnostic algorithm for clinicians and future perspectives

Abstract

Spontaneous peritonitis (SP) is the most common infection among decompensated end-stage liver disease patients. SP is the infection of ascitic fluid (neutrophil ascitic count ≥250/mL) without an alternative focus of abdominal infection. According to the causative agent, clinicians can make the diagnosis of spontaneous bacterial peritonitis or spontaneous fungal peritonitis. The mortality rate is very high, ranging from one-fifth of the patients with spontaneous bacterial peritonitis to four-fifths of the patients with spontaneous fungal peritonitis. An immediate and accurate diagnosis can improve the outcome in end-stage liver disease patients. The aim of this work is to provide physicians with a practical diagnostic guidance for SP diagnosis according to current evidence, in order to improve the management of cirrhotic patients with infected ascitic fluid.

S100A8/A9 modulates inflammatory collateral tissue damage during intraperitoneal origin systemic candidiasis

“…Peritonitis frequently results in severe sepsis in surgical patients, especially in the intensive care unit (ICU) (1), as more than 70% of patients often succumb to death within 72h (2). Hence, treatment options are required that extend life expectancy to allow proper treatment (3).…”

“…Peritonitis is characterized by inflammation of the membrane in the abdominal cavity, the peritoneum. Peritonitis often occurs upon disruption of physical barriers or can become spontaneous in severe organ failure, causing alterations of the physiologic flora residing in the gastrointestinal tract (1,4). These alterations prompt an inflammatory response that targets the removal of contaminants from the peritoneal cavity into circulation.…”

Secondary bacterial peritonitis and pelvic abscess due to Clostridium difficile

“…Advanced hepatic cirrhosis is associated with portal hypertension and bowel oedema, leading to increased gut permeability and a higher risk of bacterial translocation into the peritoneal space 1. Consequently, spontaneous bacterial peritonitis (SBP) is a relatively common infection in patients with cirrhosis and ascites.…”

“…Consequently, spontaneous bacterial peritonitis (SBP) is a relatively common infection in patients with cirrhosis and ascites. Despite improved diagnostics and early treatment interventions for this syndrome, mortality rates remain quite high, approaching 20% 1. Secondary bacterial peritonitis, however, is less frequent but has an even higher mortality rate than SBP 1.…”

“…Despite improved diagnostics and early treatment interventions for this syndrome, mortality rates remain quite high, approaching 20% 1. Secondary bacterial peritonitis, however, is less frequent but has an even higher mortality rate than SBP 1. Common bacterial pathogens associated with peritonitis in these patients include Escherichia coli , Klebsiella pneumoniae and Streptococcus pneumoniae .…”