Spontaneous Bacterial Peritonitis (SBP)

Epidemiology

  • xxxx

Physiology

  • xxx

Diagnosis

  • Paracentesis
    • WBC Count
    • xxx

Clinical Manifestations

Gastrointestinal Manifestations

Other Manifestations


Treatment

Antibiotics

  • Importance of Prompt Antibiotic Therapy
    • Delayed Antibiotic Therapy in SBP with Associated Septic Shock Significantly Increases the Mortality Rate (2015) [MEDLINE]
      • Study: retrospective cohort study from an international, multicenter database (n = 126)
      • Main Findings
        • SBP with associated septic shock carries an 81.8% in-hospital mortality rate
        • Each hour of delay in appropriate antimicrobial therapy is associated with a 1.86x increase in -inhospital mortality
        • The admission APACHE II score, admission MELD score, and admission serum lactate are all positively correlated with the in-hospital mortality rate
        • Earlier antibiotic initiation with appropriate antimicrobial therapy could significantly improve outcome

Albumin (see Albumin, [[Albumin]])

  • Clinical Efficacy

    • Trial of Albumin in Cirrhotics with SBP (NEJM, 1999) [MEDLINE]: in addition to antibiotics, intravenous albumin decreases the incidence of renal impairment and death, as compared to antibiotics alone
  • xxx

  • xxx
  • xxx

Albumin

  • Dosing: albumin 1.5 g/kg of body weight at the time of diagnosis, followed by 1 g/kg on day 3
  • Clinical Efficacy: in combination with antibiotics, therapy, albumin as been demonstrated to decrease renal impairment and mortality rate [MEDLINE]

References

  • Effect of Intravenous Albumin on Renal Impairment and Mortality in Patients with Cirrhosis and Spontaneous Bacterial Peritonitis. N Engl J Med 1999;341:403-9 [MEDLINE]
  • Appropriate and timely antimicrobial therapy in cirrhotic patients with spontaneous bacterial peritonitis-associated septic shock: a retrospective cohort study. Aliment Pharmacol Ther. 2015 Apr;41(8):747-57. Epub 2015 Feb 20 [MEDLINE]