Spontaneous Bacterial Peritonitis (SBP)

Last updated 20.09.12

 

Definition

-  Acute bacterial infection of ascitic fluid

 

Features

-  May occur in any patient with ascities

-  Ominous complication of cirrhosis

-  Usually Child-Pugh class C

-  May occur in peritoneal dialysis

-  High risk in children with nephrosis or SLE with ascities

-  Mortality rate 40-70%

-  Dx= ascitic neutrophil count >250 cells/microL + positive bacterial culture

-  Negative culture = suspected SBP

 

Assocaited S/S

-  75% aerobic G-: 50% E. Coli

-  25% aerobic G+: 20% strep

 

Assocaited S/S

-  Asymptomatic 30%

-  Chills, fever 80%

-  Nausea & vomiting

-  Abdo pain 70%

-  +/- rebound or guarding

-  Metabolic encephalopathy

-  Diarrhoea

-  Ileus

-  Hypotension 5-14%

 

Ix

-  Peritoneal fluid analysis: MCS, cytology, biochemistry (Lactate, pH)

-  >250 cells/microL

-   Neutrophils >500 cells/microL 86% sens, 98% spec

-  Blood cultures: positive in 1/3

-  Urinalysis (MSU): MCS: may predispose to SBP

 

Mx

-  Abx

-  Ceftriaxone 1g IV Daily

-  Prophylaxis: Bactrim (Trimethoprim & Sulfamethoxazole) 160mg/800mg PO Daily

 

 

 

References