Overview
Spontaneous bacterial peritonitis (SBP) is an infection of the ascitic fluid in patients with cirrhosis and ascites, often caused by enteric bacteria. It can present silently with subtle signs like cutaneous pigmentation 4.Diagnosis
Clinical suspicion in cirrhotic patients with ascites 4
Paracentesis to analyze ascitic fluid for:
- Elevated polymorphonuclear leukocyte (PMN) count (typically >250 cells/μL) 14
- Culture to identify causative organism 1
Silent SBP may present with non-specific symptoms or signs like cutaneous pigmentation 4Management
Empiric antibiotic therapy: Third-generation cephalosporins (e.g., cefotaxime) 1
Targeted therapy based on culture and sensitivity results 1
Supportive care including fluid management, inotropic support, and ventilatory support if needed 3
Monitor for complications such as multiple organ failure, bleeding, and fistulas 3Special Populations
Silent presentation noted in cirrhotic patients managed with diuretics, suggesting careful monitoring is crucial 4
No specific recommendations provided for pregnancy, pediatrics, or elderly populations in the given abstractsKey Recommendations
Perform paracentesis with ascitic fluid analysis for PMN count and culture in suspected cirrhotic patients with ascites to diagnose SBP (Evidence: Moderate 14)
Initiate empirical third-generation cephalosporin therapy for SBP and tailor based on culture results (Evidence: Moderate 1)
Closely monitor for silent progression and complications like multiple organ failure and sepsis in patients with SBP (Evidence: Moderate 34)References
1 Patel S, Gandhi D, Mehta V, Bhatia K, Epelbaum O. Plesiomonas shigelloides : an extremely rare cause of Spontaneous Bacterial Peritonitis. Acta gastro-enterologica Belgica 2016. link
2 Runyon BA. Early events in spontaneous bacterial peritonitis. Gut 2004. link
3 Bosscha K, Hulstaert PF, Visser MR, van Vroonhoven TJ, van der Werken C. Open management of the abdomen and planned reoperations in severe bacterial peritonitis. The European journal of surgery = Acta chirurgica 2000. link
4 Pollack S, Haim S, Enat R, Barzilai D. Cutaneous pigmentation: a probable sign of spontaneous bacterial peritonitis. Dermatologica 1980. link