Bacterial infection of the ascites fluid , most commonly by Escherichia coli or Klebsiella pneumoniae , causes the condition. Its prevalence in patients with cirrhosis is 10.8% in North America, and almost 25% of patients die despite appropriate antibiotic treatment.
Presentation varies and patients may not have abdominal pain or fever.
Spontaneous bacterial peritonitis is usually a trigger for cirrhotic decompensation, which may manifest as isolated hepatic encephalopathy, gastrointestinal bleeding, renal failure, increased ascites volume, or any abnormality of vital signs, including hypothermia.
Given its highly variable presentation, current guidance recommends that any patient presenting urgently to hospital with cirrhosis and ascites be screened for the condition.
Prompt diagnosis is required to reduce the risk of death.
A paracentesis showing ascites fluid with a polymorphonuclear leukocyte count of 250 cells/mm3 (0.25 × 109/L) or more confirms the diagnosis. In 1 study, delaying paracentesis for 12 hours resulted in a 2.7-fold increase in the odds of death. Doctors should perform a paracentesis as soon as possible.4
Empirical antibiotic treatment requires consideration of local resistance patterns
In North America, antibiotic resistance in spontaneous bacterial peritonitis is 17.8%, with methicillin-resistant Staphylococcus aureus being the most common resistant organism.
Empirical treatment in areas of low resistance is a third-generation cephalosporin, and in areas of high resistance is piperacillin. tazobactam.
Clinicians must prescribe albumin within 6 hours of diagnosis to confer a mortality benefit.
Albumin has a number needed to treat of 6 patients to prevent 1 death and 4 patients to prevent 1 case of renal failure, if administered within 6 hours of diagnosis of spontaneous bacterial peritonitis.
The most recent guideline recommends that, in addition to fluid resuscitation, albumin be given to all patients with the condition. The recommended albumin dose is 1.5 g/kg on day 1 and 1 g/kg on day 3.
