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Spontan bakterielle Peritonitis

Spontaneous bacterial peritonitis

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Zusammenfassung

Die spontan bakterielle Peritonitis (SBP) ist die häufigste Infektion bei Hospitalisation wegen einer Leberzirrhose. Sie ist prognostisch bedeutend für den Krankheitsverlauf und das Gesamtüberleben. Der Goldstandard zur Diagnostik ist eine Parazentese vor Beginn einer antiinfektiven Therapie mit Nachweis der Erhöhung der neutrophilen Granulozyten (> 250/µl). Die Auswahl des Antibiotikums zur Therapie ist insbesondere abhängig von der Vortherapie. Bei fehlender Kontraindikation ist stets eine Lebertransplantation als kurative Therapieoption der Leberzirrhose zu evaluieren. Eine prophylaktische antibiotische Therapie ist bei Patienten mit Aszites und gastrointestinaler Blutung indiziert, ferner besteht eine Indikation für eine Sekundärprophylaxe bei Patienten mit stattgehabter SBP. Eine Primärprophylaxe ist bei Hochrisikopatienten angezeigt, allerdings ist immer die Gefahr der Resistenzentwicklung zu berücksichtigen.

Abstract

Spontaneous bacterial peritonitis (SBP) is the most frequent infection in patients with cirrhosis during hospitalization and is associated with high acute and long-term mortality. Diagnosis is made by paracentesis with determination of neutrophil count in ascitic fluid. Empirical antibiotic therapy must be initiated immediately. The choice of drug is dependent on prior therapies. Liver transplantation has to be considered in the absence of contra-indications. Prophylaxis of SBP is indicated in patients with ascites and gastrointestinal hemorrhage, and in patients after SBP. Primary prophylaxis should be considered in high-risk patients with cirrhosis and ascites. The development of resistance to antibiotic drugs is a relevant side-effect.

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  1. Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93042, Regensburg, Deutschland

    S.A. Schmid, B. Salzberger & F. Klebl

  2. Gastroenterologie, Inselspital Bern, Bern, Schweiz

    R. Wiest

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  1. S.A. Schmid
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  2. R. Wiest
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  3. B. Salzberger
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  4. F. Klebl
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Correspondence to S.A. Schmid.

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Schmid, S., Wiest, R., Salzberger, B. et al. Spontan bakterielle Peritonitis. Med Klin Intensivmed Notfmed 107, 548–552 (2012). https://doi.org/10.1007/s00063-012-0084-3

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  • DOI: https://doi.org/10.1007/s00063-012-0084-3

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