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Spontaneous Bacterial Peritonitis

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Evidence-Based Critical Care

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Abstract

Spontaneous bacterial peritonitis (SBP) is a frequent and serious complication of ascites in the presence of advanced cirrhosis. Although SBP can be considered in other conditions associated with the presence of chronic ascites, SBP is most commonly associated with ascites from cirrhosis and its presence correlates with more advanced liver disease. SBP is defined as an ascitic fluid infection in the absence of a surgical etiology. Delay in recognition and appropriate treatment of peritoneal infections such as SBP can lead to sepsis and death. Symptoms include fever, abdominal pain, nausea and altered mental status although patients can be asymptomatic. Translocation of enteric bacteria from the gut into the peritoneal cavity accounts for the majority of SBP cases; however, other organisms, (fungal, mycobacteria, and more resistant nosocomial bacteria), can also be pathogenic and lead to peritonitis. The clinical diagnosis of SBP is suspected by the presence of ascites and compatible symptoms and is confirmed by ascitic fluid analysis showing elevated polymorphonuclear cells and a positive microbiologic culture. It is imperative to rule out secondary causes of peritonitis. Treatment primarily includes antibiotics and adjunctive albumin therapy in appropriate patients. Prophylaxis is a cornerstone of therapy for patients meeting criteria. Early identification and management of SBP has transformed this condition from one carrying a high mortality rate to a fairly well-managed and treated complication of chronic ascites in cirrhotic patients.

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Author information

Authors and Affiliations

  1. Department of Internal Medicine, Highland Hospital, Alameda Health System, Oakland, CA, USA

    Ajay M. Ohri

  2. Pulmonary and Critical Care Faculty, Department of Internal Medicine, Highland Hospital, Alameda Health System, Oakland, CA, USA

    Indhu M. Subramanian

Authors
  1. Ajay M. Ohri
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  2. Indhu M. Subramanian
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Correspondence to Ajay M. Ohri .

Editor information

Editors and Affiliations

  1. Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA

    Robert C. Hyzy

  2. Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA

    Jakob McSparron

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Ohri, A.M., Subramanian, I.M. (2020). Spontaneous Bacterial Peritonitis. In: Hyzy, R.C., McSparron, J. (eds) Evidence-Based Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-26710-0_74

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  • DOI: https://doi.org/10.1007/978-3-030-26710-0_74

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