Spontaneous bacterial peritonitis - Revision history

Ostermayer: Prepared the page for translation

2026-01-04T23:59:24Z

Prepared the page for translation

← Older revision		Revision as of 23:59, 4 January 2026
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	''See [[Peritoneal dialysis-associated peritonitis]] for PD peritonitis		<languages/>
			<translate>
			''See [[Special:MyLanguage/Peritoneal dialysis-associated peritonitis\|Peritoneal dialysis-associated peritonitis]] for PD peritonitis

	==Background==		==Background==
	*Develops in large, clinically obvious [[ascites]] secondary to cirrhosis
			*Develops in large, clinically obvious [[Special:MyLanguage/ascites\|ascites]] secondary to cirrhosis
	**Portal hypertension → bowel edema → normal flora translocates across bowel wall into the peritoneum		**Portal hypertension → bowel edema → normal flora translocates across bowel wall into the peritoneum
	*30% of ascitic patients will develop spontaneous bacterial peritonitis (SBP) in a given year		*30% of ascitic patients will develop spontaneous bacterial peritonitis (SBP) in a given year


	===Causative Agents===		===Causative Agents===
	*[[Enterobacter]] (63%)
	*[[Pneumococcus]] (15%)		*[[Special:MyLanguage/Enterobacter\|Enterobacter]] (63%)
	*[[Entercocci]] (10%)		*[[Special:MyLanguage/Pneumococcus\|Pneumococcus]] (15%)
	*[[Anaerobes]] (<1%)		*[[Special:MyLanguage/Entercocci\|Entercocci]] (10%)
			*[[Special:MyLanguage/Anaerobes\|Anaerobes]] (<1%)


	==Clinical Features==		==Clinical Features==
	[[File:Hepaticfailure.jpg\|thumb\|\|Ascites secondary to [[cirrhosis]].]]
	*[[Fever]] (70%)		[[File:Hepaticfailure.jpg\|thumb\|\|Ascites secondary to [[Special:MyLanguage/cirrhosis\|cirrhosis]].]]
	*[[Abdominal pain]] (diffuse) (60%)		*[[Special:MyLanguage/Fever\|Fever]] (70%)
	*[[Altered mental status]] (55%)		*[[Special:MyLanguage/Abdominal pain\|Abdominal pain]] (diffuse) (60%)
			*[[Special:MyLanguage/Altered mental status\|Altered mental status]] (55%)
	*~15% are asymptomatic		*~15% are asymptomatic
	**Therefore have a low threshold to perform diagnostic [[paracentesis]], especially if patient is to be admitted		**Therefore have a low threshold to perform diagnostic [[Special:MyLanguage/paracentesis\|paracentesis]], especially if patient is to be admitted


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{Abdominal Pain DDX Diffuse}}		{{Abdominal Pain DDX Diffuse}}
			<translate>
			</translate>
	{{DDX abdominal distention}}		{{DDX abdominal distention}}
			<translate>


	==Evaluation==		==Evaluation==

	[[File:PMC4879078 40792 2016 173 Fig1 HTML.png\|thumb\|Although not the diagnostic test of choice, acute abdominal CT of SBP (top images) shows ascites and thickened intestinal wall (arrowhead). Bottom images show resolution after discharge.]]		[[File:PMC4879078 40792 2016 173 Fig1 HTML.png\|thumb\|Although not the diagnostic test of choice, acute abdominal CT of SBP (top images) shows ascites and thickened intestinal wall (arrowhead). Bottom images show resolution after discharge.]]
	''Consider alternative diagnoses at the same time''		''Consider alternative diagnoses at the same time''
			</translate>
	{{SBP workup}}		{{SBP workup}}
			<translate>
			</translate>
	{{Diagnosis of SBP}}		{{Diagnosis of SBP}}
			<translate>
			</translate>
	{{Spontaneous versus secondary bacterial peritonitis}}		{{Spontaneous versus secondary bacterial peritonitis}}
			<translate>


	==Management==		==Management==
	===[[Antibiotics]]===
	*3rd-generation [[cephalosporin]]:
	**[[Cefotaxime]] 2g IV q8hr or [[Ceftriaxone]] 1-2g IV q12-24hr		===[[Special:MyLanguage/Antibiotics\|Antibiotics]]===
	*If [[beta-lactam]] allergy, [[ciprofloxacin]] 400mg IV q12hr
	*If peritoneal dialysis: [[vancomycin]] and [[cefepime]] <ref>Haines EJ, Oyama LC: Disorders of the Liver and Biliary Tract, in Walls RM, Hockberger RS, Gausche-Hill M, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 9. Philadelphia, Elsevier 2018, (Ch) 80:p 1083-1103.</ref>		*3rd-generation [[Special:MyLanguage/cephalosporin\|cephalosporin]]:
			**[[Special:MyLanguage/Cefotaxime\|Cefotaxime]] 2g IV q8hr or [[Special:MyLanguage/Ceftriaxone\|Ceftriaxone]] 1-2g IV q12-24hr
			*If [[Special:MyLanguage/beta-lactam\|beta-lactam]] allergy, [[Special:MyLanguage/ciprofloxacin\|ciprofloxacin]] 400mg IV q12hr
			*If peritoneal dialysis: [[Special:MyLanguage/vancomycin\|vancomycin]] and [[Special:MyLanguage/cefepime\|cefepime]] <ref>Haines EJ, Oyama LC: Disorders of the Liver and Biliary Tract, in Walls RM, Hockberger RS, Gausche-Hill M, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 9. Philadelphia, Elsevier 2018, (Ch) 80:p 1083-1103.</ref>


	===Albumin===		===Albumin===

	''Reduces renal failure and hospital mortality if given within 6 hours''<ref>Jamtgaard, et al. Does albumin infusion reduce renal impairment and mortality in patients with SBP. Annals of EM. April 2016. 67(4):458-458.</ref><ref>Sort, P et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med. 1999 Aug 5;341(6):403-9.</ref><ref>Xue, HP et al. Effect of albumin infusion on preventing the deterioration of renal function in patients with spontaneous bacterial peritonitis. Chinese Journal of Digestive Diseases, 2002 Jan 3: 32-34.</ref>		''Reduces renal failure and hospital mortality if given within 6 hours''<ref>Jamtgaard, et al. Does albumin infusion reduce renal impairment and mortality in patients with SBP. Annals of EM. April 2016. 67(4):458-458.</ref><ref>Sort, P et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med. 1999 Aug 5;341(6):403-9.</ref><ref>Xue, HP et al. Effect of albumin infusion on preventing the deterioration of renal function in patients with spontaneous bacterial peritonitis. Chinese Journal of Digestive Diseases, 2002 Jan 3: 32-34.</ref>
	*Give for all or (larger effect) if creatinine >1mg/dL, BUN >30mg/dL, or T Bili >4mg/dL		*Give for all or (larger effect) if creatinine >1mg/dL, BUN >30mg/dL, or T Bili >4mg/dL
	*1.5gm/kg at within 6 hrs of diagnosis; 1gm/kg on day 3		*1.5gm/kg at within 6 hrs of diagnosis; 1gm/kg on day 3


	==Disposition==		==Disposition==

	*Most admitted		*Most admitted
	**Can consider discharge with PO antibiotics if has mild, uncomplicated disease and close follow up		**Can consider discharge with PO antibiotics if has mild, uncomplicated disease and close follow up


	==See Also==		==See Also==
	*[[Paracentesis]]
	*[[Peritoneal dialysis-associated peritonitis]]		*[[Special:MyLanguage/Paracentesis\|Paracentesis]]
	*[[In-Training Exam Review]]		*[[Special:MyLanguage/Peritoneal dialysis-associated peritonitis\|Peritoneal dialysis-associated peritonitis]]
			*[[Special:MyLanguage/In-Training Exam Review\|In-Training Exam Review]]


	==References==		==References==

	<references/>		<references/>

	[[Category:GI]]		[[Category:GI]]
			</translate>

Elcatracho: /* Clinical Features */

2022-01-05T10:33:59Z

Clinical Features

← Older revision		Revision as of 10:33, 5 January 2022
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	*[[Altered mental status]] (55%)		*[[Altered mental status]] (55%)
	*~15% are asymptomatic		*~15% are asymptomatic
			**Therefore have a low threshold to perform diagnostic [[paracentesis]], especially if patient is to be admitted

	==Differential Diagnosis==		==Differential Diagnosis==

Elcatracho: /* See Also */

2021-02-23T20:42:42Z

Rossdonaldson1: /* Differential Diagnosis */

2021-01-27T20:08:31Z

Differential Diagnosis

← Older revision		Revision as of 20:08, 27 January 2021
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	==Differential Diagnosis==		==Differential Diagnosis==
	*[[Peritoneal dialysis-associated peritonitis]]

	{{Abdominal Pain DDX Diffuse}}		{{Abdominal Pain DDX Diffuse}}
			{{DDX abdominal distention}}

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Clinical Features */

2021-01-27T19:58:59Z

Clinical Features

← Older revision		Revision as of 19:58, 27 January 2021
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	==Clinical Features==		==Clinical Features==
			[[File:Hepaticfailure.jpg\|thumb\|\|Ascites secondary to [[cirrhosis]].]]
	*[[Fever]] (70%)		*[[Fever]] (70%)
	*[[Abdominal pain]] (diffuse) (60%)		*[[Abdominal pain]] (diffuse) (60%)

Rossdonaldson1: /* Background */

2021-01-27T19:58:22Z

Background

← Older revision		Revision as of 19:58, 27 January 2021
Line 1:		Line 1:
	''See [[Peritoneal dialysis-associated peritonitis]] for PD peritonitis		''See [[Peritoneal dialysis-associated peritonitis]] for PD peritonitis
	==Background==		==Background==
	*Develops in large, clinically obvious ascites secondary to cirrhosis		*Develops in large, clinically obvious [[ascites]] secondary to cirrhosis
	**Portal hypertension → bowel edema → normal flora translocates across bowel wall into the peritoneum		**Portal hypertension → bowel edema → normal flora translocates across bowel wall into the peritoneum
	*30% of ascitic patients will develop spontaneous bacterial peritonitis (SBP) in a given year		*30% of ascitic patients will develop spontaneous bacterial peritonitis (SBP) in a given year

Rossdonaldson1: /* Evaluation */

2021-01-27T19:57:41Z

Evaluation

← Older revision		Revision as of 19:57, 27 January 2021
Line 23:		Line 23:

	==Evaluation==		==Evaluation==
			[[File:PMC4879078 40792 2016 173 Fig1 HTML.png\|thumb\|Although not the diagnostic test of choice, acute abdominal CT of SBP (top images) shows ascites and thickened intestinal wall (arrowhead). Bottom images show resolution after discharge.]]
	''Consider alternative diagnoses at the same time''		''Consider alternative diagnoses at the same time''
	{{SBP workup}}		{{SBP workup}}

Elcatracho: /* Management */

2021-01-01T06:11:51Z

Management

← Older revision		Revision as of 06:11, 1 January 2021
Line 33:		Line 33:
	**[[Cefotaxime]] 2g IV q8hr or [[Ceftriaxone]] 1-2g IV q12-24hr		**[[Cefotaxime]] 2g IV q8hr or [[Ceftriaxone]] 1-2g IV q12-24hr
	*If [[beta-lactam]] allergy, [[ciprofloxacin]] 400mg IV q12hr		*If [[beta-lactam]] allergy, [[ciprofloxacin]] 400mg IV q12hr
	*If peritoneal dialysis: vancomycin and cefepime <ref>Haines EJ, Oyama LC: Disorders of the Liver and Biliary Tract, in Walls RM, Hockberger RS, Gausche-Hill M, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 9. Philadelphia, Elsevier 2018, (Ch) 80:p 1083-1103.</ref>		*If peritoneal dialysis: [[vancomycin]] and [[cefepime]] <ref>Haines EJ, Oyama LC: Disorders of the Liver and Biliary Tract, in Walls RM, Hockberger RS, Gausche-Hill M, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 9. Philadelphia, Elsevier 2018, (Ch) 80:p 1083-1103.</ref>

	===Albumin===		===Albumin===

Elcatracho: /* Management */

2021-01-01T06:11:13Z

Management

← Older revision		Revision as of 06:11, 1 January 2021
Line 33:		Line 33:
	**[[Cefotaxime]] 2g IV q8hr or [[Ceftriaxone]] 1-2g IV q12-24hr		**[[Cefotaxime]] 2g IV q8hr or [[Ceftriaxone]] 1-2g IV q12-24hr
	*If [[beta-lactam]] allergy, [[ciprofloxacin]] 400mg IV q12hr		*If [[beta-lactam]] allergy, [[ciprofloxacin]] 400mg IV q12hr
			*If peritoneal dialysis: vancomycin and cefepime <ref>Haines EJ, Oyama LC: Disorders of the Liver and Biliary Tract, in Walls RM, Hockberger RS, Gausche-Hill M, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 9. Philadelphia, Elsevier 2018, (Ch) 80:p 1083-1103.</ref>

	===Albumin===		===Albumin===

Alvarez13: /* Albumin */

2018-11-22T05:43:02Z

Albumin

← Older revision		Revision as of 05:43, 22 November 2018
Line 35:		Line 35:

	===Albumin===		===Albumin===
	''Reduces renal failure and hospital mortality if given within 6 hours''<ref>Jamtgaard, et al. Does albumin infusion reduce renal impairment and mortality in patients with SBP. Annals of EM. April 2016. 67(4):458-458.</ref>		''Reduces renal failure and hospital mortality if given within 6 hours''<ref>Jamtgaard, et al. Does albumin infusion reduce renal impairment and mortality in patients with SBP. Annals of EM. April 2016. 67(4):458-458.</ref><ref>Sort, P et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med. 1999 Aug 5;341(6):403-9.</ref><ref>Xue, HP et al. Effect of albumin infusion on preventing the deterioration of renal function in patients with spontaneous bacterial peritonitis. Chinese Journal of Digestive Diseases, 2002 Jan 3: 32-34.</ref>
	*1.~~5gm/kg at diagnosis~~; ~~1gm~~/kg on ~~day~~ 3
	*Give for all or (larger effect) if creatinine >1mg/dL, BUN >30mg/dL, or T Bili >4mg/dL		*Give for all or (larger effect) if creatinine >1mg/dL, BUN >30mg/dL, or T Bili >4mg/dL
			*1.5gm/kg at within 6 hrs of diagnosis; 1gm/kg on day 3

	==Disposition==		==Disposition==

← Older revision		Revision as of 20:42, 23 February 2021
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	*[[Paracentesis]]		*[[Paracentesis]]
	*[[Peritoneal dialysis-associated peritonitis]]		*[[Peritoneal dialysis-associated peritonitis]]
			*[[In-Training Exam Review]]

	==References==		==References==