Spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis is a bacterial infection of the ascites without any detectable or surgically treatable source of the infection. This is a common complication of ascites (30%) of cirrhotic origin.

Etiology and pathogenesis

 * The source of the infection is probably the intestine - the infection passes through the intact intestinal wall through translocations
 * ascites with low opsonic activity are more susceptible to spontaneous bacterial peritonitis,
 * infectious agents are mostly facultative anaerobic gram negative intestinal bacteria: E. coli, Klebsiella, Enterobacter, Proteus.

Clinical manifestation

 * Signs are variable + mostly insignificant,
 * infection can manifest with ↑ accumulation of the ascites + failure of the diuretic treatment, or with the liver insufficiency,
 * subfebrile temperature + diffuse abdominal pain,
 * often manifest after the bleeding of the esophageal varices,
 * untreated bacterial peritonitis has lethality about 30 %.

Diagnostics

 * Diagnostic paracentesis with ascites examination: cultivation, leukocytes > 0,4 x 109/l → start treatment.

Therapy

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

Prognosis

 * Poor (relapse, worsening of liver + renal function).