Spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis is a bacterial infection of the ascites wihout any detectable or surgically removable source of the infecion. It often complicates the ascites (30 %) caused by the liver cirrhosis.

Etiology and pathogenesis

 * The infection probably comes from the intestines - it translocates through the intact intestine wall,
 * ascites with low opsonic activity is more predisposed to spontaneus bacterial peritonitis,
 * infectious agents are mostly facultative anaerobic gram negative intestinal bacteria: E. coli, Klebsiella, Enterobacter, Proteus.

Clinical manifestation

 * Signs are variable + mostly are not expressive,
 * infection may manifest with ↑ accumulation of the ascites + failure of the diuretic therapy, or with the liver insufficiency,
 * subfebrile temperature + diffuse stomach ache,
 * often manifests after the bleeding of the esophageal varices,
 * uncured bacterial peritonitis has lethality about 30 %.

Diagnosing

 * Diagnostic paracentesis with ascites investigation: cultivation, white blood cells > 0,4 x 109/l → begin treatment.

Therapy

 * Cephalosporins of the third generation (cefotaxime, 2 g every 8 hours), albumin (prevention of the hypovolemia - hepatorenal syndrome),
 * selective intestinal decontamination by the non-absorbable antibiotics (norfloxacin 400 g) – prevention.

Prognosis

 * Bad (relapse, liver and renal tests are getting worse).