Spontaneous Bacterial Peritonitis

Perform diagnostic paracentesis in a patient with cirrhosis and ascites when SBP is clinically suspected, including fever, abdominal pain or tenderness, or other evidence of infection. Diagnostic paracentesis is the basis of diagnosis, and ascites is associated with substantial SBP risk: prevalence is approximately 1.5% to 3.5% among outpatients and about 10% among hospitalized patients with cirrhosis. easl eu+1easl eu[PDF] Hepatorenal-Cirrhosis-English-report.pdf - EASLPubMedKASL clinical practice guidelines for liver cirrhosis: Ascites ... - PMC

Send ascitic fluid for cell count with differential and culture. Culture-negative neutrocytic ascites is managed as SBP when the PMN count is greater than 250/mm3. Gram stain is frequently negative and should not delay empiric treatment. ScienceDirect+1ScienceDirectPeritoneum Exudate - an overview | ScienceDirect TopicsPubMedKASL clinical practice guidelines for liver cirrhosis: Ascites ... - PMC

Obtain targeted ascitic studies when the presentation points away from uncomplicated SBP: add ascitic amylase for suspected pancreatic ascites, mycobacterial culture or PCR when tuberculosis is suspected, and cytology when malignancy is suspected. Ascitic glucose and lactate dehydrogenase help assess for secondary peritonitis. PubMed+1PubMedThe clinical management of abdominal ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: a review of current guidelines and recommendations. - AbstractPubMedAscites - StatPearls - NCBI Bookshelf

For presumed community-acquired SBP, a third-generation cephalosporin is a standard empiric option. Cefotaxime has guideline support and effective regimens include 2 g intravenously every 6 hours or every 12 hours; ceftriaxone 2 g intravenously every 24 hours is another reported regimen. Third-generation cephalosporins avoid the nephrotoxicity associated with aminoglycoside-containing empiric regimens. ScienceDirect+2ScienceDirectSpontaneous Bacterial Peritonitis - an overview | ScienceDirect TopicsScienceDirectPeritoneum Exudate - an overview | ScienceDirect TopicsPubMedThe clinical management of abdominal ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: a review of current guidelines and recommendations. - Abstract

Obtain ascitic fluid culture before antibiotics when this does not delay treatment, then narrow or modify therapy according to organism identification and susceptibility testing. Common implicated organisms include Escherichia coli, Klebsiella species, enterococci, and other gram-negative enteric flora; healthcare-associated and nosocomial SBP have greater multidrug-resistant and gram-positive pathogen concerns. ScienceDirect+2ScienceDirectSpontaneous Bacterial Peritonitis - an overview | ScienceDirect TopicsWileyAntibiotic resistance in healthcare‐related and nosocomial ...PubMedEvaluation of the current guidelines for antibacterial therapy strategies in patients with cirrhosis or liver failure

For healthcare-associated or nosocomial SBP, do not assume a community-acquired cephalosporin regimen will be adequate. EASL 2018 guidance emphasized adding gram-positive-active agents such as a glycopeptide, daptomycin, or linezolid in settings with high gram-positive infection prevalence; choose the regimen in conjunction with local antibiograms and the patient's prior antimicrobial exposure. PubMedPubMedEvaluation of the current guidelines for antibacterial therapy strategies in patients with cirrhosis or liver failure

Co-administer intravenous albumin with antibacterial therapy in SBP using 1.5 g/kg at diagnosis and 1 g/kg on day 3. In patients treated with cefotaxime, this strategy reduced the incidence of type 1 hepatorenal syndrome and mortality. ScienceDirectScienceDirectSpontaneous Bacterial Peritonitis - an overview | ScienceDirect Topics

Follow renal function during acute infection because renal impairment after SBP has major prognostic implications and SBP is linked to hepatorenal syndrome. Worsening kidney function should prompt reassessment of infection control, circulatory status, and competing renal injury mechanisms rather than assuming uncomplicated SBP is resolving. ScienceDirect+2ScienceDirectSpontaneous Bacterial Peritonitis - an overview | ScienceDirect TopicsPubMedKASL clinical practice guidelines for liver cirrhosis: Ascites ... - PMCPubMedDiagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. - Abstract

SBP requires infection of ascites without a contiguous intra-abdominal source such as bowel perforation or intra-abdominal abscess. If abdominal findings are disproportionate, the ascitic fluid profile is atypical, or the patient fails to improve on appropriate empiric therapy, evaluate for secondary bacterial peritonitis rather than simply extending the original regimen. ScienceDirect+2ScienceDirectSpontaneous Bacterial Peritonitis - an overview | ScienceDirect Topicseasl eu[PDF] EASL Clinical Practice Guidelines for the management of patients ...PubMedAscites - StatPearls - NCBI Bookshelf

Use ascitic glucose and lactate dehydrogenase as part of the secondary-peritonitis assessment, then direct imaging and source-control evaluation to the suspected pathology. Pancreatitis and tuberculosis should be pursued selectively with ascitic amylase and mycobacterial culture or PCR, respectively, rather than applying those tests routinely. PubMed+1PubMedThe clinical management of abdominal ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: a review of current guidelines and recommendations. - AbstractPubMedAscites - StatPearls - NCBI Bookshelf

Do not equate ascitic culture negativity with treatment failure or diagnostic exclusion. A PMN count greater than 250/mm3 establishes SBP even if cultures are negative; the key reassessment question is whether the clinical course and fluid findings remain consistent with a spontaneous rather than secondary source. PubMed+1PubMedKASL clinical practice guidelines for liver cirrhosis: Ascites ... - PMCGastroenterologyUtility of an Algorithm in Differentiating Spontaneous From ...

After recovery from SBP, prescribe long-term secondary prophylaxis with daily norfloxacin or trimethoprim-sulfamethoxazole. Norfloxacin and trimethoprim-sulfamethoxazole have similar efficacy for SBP prevention. Wiley+1WileyReview article: spontaneous bacterial peritonitis - Wiley Online LibraryPubMedCiprofloxacin: Spontaneous Bacterial Peritonitis (Prevention) - PMC

During gastrointestinal hemorrhage in a patient with cirrhosis, give antibacterial prophylaxis for 7 days. AASLD guidance cited intravenous ceftriaxone or oral norfloxacin; start with a parenteral antibiotic during active bleeding and transition to an oral agent when oral intake resumes, completing 7 days total. PubMedPubMedCiprofloxacin: Spontaneous Bacterial Peritonitis (Prevention) - PMC

For primary prophylaxis in selected patients with cirrhosis and ascites, guideline appraisals describe long-term norfloxacin 400 mg daily in those with low ascitic fluid protein. Ciprofloxacin is an alternative to norfloxacin, but AASLD preference for daily rather than weekly ciprofloxacin reflects concern that weekly dosing may increase quinolone resistance. PubMed+1PubMedCiprofloxacin: Spontaneous Bacterial Peritonitis (Prevention) - PMCPubMedEvaluation of the current guidelines for antibacterial therapy strategies in patients with cirrhosis or liver failure