Korean J Gastroenterol.  2018 Aug;72(2):56-63. 10.4166/kjg.2018.72.2.56.

Spontaneous Bacterial Peritonitis

• Song DS

• KMID: 2418764
• DOI: http://doi.org/10.4166/kjg.2018.72.2.56

Abstract

Spontaneous bacterial peritonitis (SBP) is defined as bacterial infections that occur in patients with cirrhosis and ascites without any significant intraperitoneal infection, accounting for approximately 10-30% of bacterial infections in hospitalized patients. SBP develops in patients with liver cirrhosis because bacterial translocations are increased by changes in the intestinal bacteria and mucosal barriers. In addition, the decreased host immune response cannot remove the bacteria and their products. The most common cause of SBP is Gram-negative bacteria, such as Escherichia coli and Klebsiella species, and infections by Gram-positive bacteria are increasing. SBP is diagnosed by the presence of >250 polymorphonuclear leukocyte/mm³ in ascites after paracentesis. If SBP is diagnosed, empirical antibiotic therapy should be started immediately. Empirical antibiotic treatment should distinguish between community acquired infections and nosocomial infections. Cirrhotic patients with gastrointestinal bleeding or low ascitic protein concentrations should consider primary prevention and those who recover from SBP should consider secondary prevention. This review describes the pathophysiology, diagnosis, treatment, and prevention of SBP.

Keyword

Spontaneous bacterial peritonitis; Ascites; Therapy

MeSH Terms

Ascites
Bacteria
Bacterial Infections
Community-Acquired Infections
Cross Infection
Diagnosis
Escherichia coli
Fibrosis
Gram-Negative Bacteria
Gram-Positive Bacteria
Hemorrhage
Humans
Klebsiella
Liver Cirrhosis
Paracentesis
Peritonitis*
Primary Prevention
Secondary Prevention