Spontaneous bacterial peritonitis

Abstract:

Spontaneous bacterial peritonitis is a complication of advanced liver cirrhosis. It is defined as infection of ascitic fluid without an evident surgically treatable intraabdominal cause. The most common causative agents of spontaneous bacterial peritonitis are Escherichia coli, Klebsiella pneumoniae and Streptoccocus pneumoniae. Clinical manifestations of the condition are fever, abdominal pain, deterioration of mental status, abdominal tenderness, diarrhoea, paralytic ileus, hypotension, hypothermia and, in rare cases, shock. On the other hand, 10-15% of the patients are asymptomatic. Antibiotic treatment should be started when polymorphonuclear cell count in ascitic fluid increases above 250/mm3, even before the results of microbiological analysis are obtained. Sometimes, in case of severe clinical picture, antibiotic therapy may be introduced even before determination of the polymorphonuclear cell count. Primary and secondary prevention of spontaneous bacterial peritonitis is important in patients with decompensated liver cirrhosis. 

Key words:
ascitic fluid; bacterial translocation; infection; peritonitis