From the Guidelines
Spontaneous Bacterial Peritonitis (SBP) should be suspected in any cirrhotic patient with ascites who presents with fever, abdominal pain, altered mental status, or unexplained clinical deterioration, and diagnostic paracentesis should be performed immediately to confirm the diagnosis. This is based on the most recent and highest quality study, which emphasizes the importance of prompt diagnosis and treatment of SBP to reduce morbidity and mortality 1.
Key Indications for Suspecting SBP
- Fever
- Abdominal pain
- Altered mental status
- Unexplained clinical deterioration
- Laboratory findings such as leukocytosis, elevated C-reactive protein, or worsening liver or kidney function tests without another clear explanation
Importance of Diagnostic Paracentesis
Diagnostic paracentesis is crucial for confirming the diagnosis of SBP, and it should be performed immediately when SBP is suspected. The ascitic fluid should be sent for cell count with differential, culture, and biochemical analysis. The diagnosis is confirmed when the ascitic fluid neutrophil count exceeds 250 cells/mm³, regardless of culture results 1.
Prompt Treatment
Prompt diagnosis and treatment of SBP are critical to reduce morbidity and mortality. Third-generation cephalosporins like ceftriaxone 1-2g IV daily for 5-7 days, or alternatives such as ciprofloxacin in patients with non-severe penicillin allergies, are typically recommended for the treatment of SBP 1.
High-Risk Patients
Patients with advanced cirrhosis, low ascitic fluid protein (<1.5 g/dL), or a history of previous SBP are at higher risk of developing SBP, and a high index of suspicion is necessary in these patients 1.
Empirical Antibiotic Therapy
Empirical antibiotic therapy should be started immediately when SBP is suspected, and the choice of antibiotic should be guided by local resistance patterns and the severity of the infection 1.
Conclusion is not allowed, so the response is ended here.
From the Research
Suspecting Spontaneous Bacterial Peritonitis (SBP)
SBP should be suspected in patients with cirrhosis and ascites who present with certain clinical symptoms and signs. The following are indicators that may suggest SBP:
- Abdominal pain or tenderness 2, 3, 4
- Fever 2, 3, 4
- Altered mental status 2, 3
- Gastrointestinal bleeding 2, 4
- Signs of peritoneal irritation 4
- Changes in gastrointestinal motility, such as nausea, vomiting, diarrhea, or ileus 4
Diagnostic Considerations
Diagnostic paracentesis should be performed in patients with cirrhosis and ascites who have a clinical suspicion for SBP, unless the patient has a platelet count less than 40,000-50,000/μL 2. The diagnosis of SBP is typically made by analyzing the ascitic fluid for polymorphonuclear cell count and culture 3, 4, 5, 6.
Laboratory Diagnosis
The laboratory diagnosis of SBP is based on the following criteria:
- Polymorphonuclear cell count in the ascitic fluid greater than 250 cells/mm^3 2, 4, 6
- Positive culture from the ascitic fluid, which is characteristically monomicrobial 3, 4, 5
- The presence of leukocyte esterase in the ascitic fluid, which can be used for rapid diagnosis 4
High-Risk Patients
Patients with certain conditions are at higher risk for developing SBP and may benefit from prophylactic treatment, including: