From the Guidelines
SBP abdomen refers to Spontaneous Bacterial Peritonitis, a serious infection of the peritoneal fluid in the abdomen that occurs without an obvious source of contamination, primarily affecting patients with cirrhosis and ascites.
Diagnosis and Treatment
Diagnosis involves a paracentesis (removal of ascitic fluid) with analysis showing an elevated neutrophil count exceeding 250 cells/mm³.
- Treatment typically consists of antibiotics such as ceftriaxone or cefotaxime for 5-7 days, as recommended by the EASL clinical practice guidelines for the management of patients with decompensated cirrhosis 1.
- In hospitalized patients, albumin infusion (1.5 g/kg on day 1 and 1 g/kg on day 3) is often added to improve outcomes, as it has been shown to reduce the incidence of renal impairment and death in patients with SBP 1.
Prevention of Recurrence
Patients who recover from an episode of SBP should receive long-term antibiotic prophylaxis, typically with norfloxacin 400mg daily or trimethoprim-sulfamethoxazole, to prevent recurrence.
- The choice of empirical antibiotic therapy should be based on the severity of infection, the environment of the infection (community-acquired, health care-associated, or nosocomial), and local resistance profiles, as recommended by the EASL clinical practice guidelines 1.
Key Considerations
- SBP is a serious condition with high mortality rates if left untreated, as bacteria from the gut translocate into the ascitic fluid due to increased intestinal permeability and impaired immune function in cirrhotic patients.
- The landscape of bacterial resistance is continuously changing, and it is crucial to consider the local resistance profile when deciding on empirical antibiotic treatment 1.
From the Research
Definition of SBP Abdomen
- Spontaneous Bacterial Peritonitis (SBP) is an infection of the ascitic fluid in patients with advanced liver disease and ascites 2, 3, 4.
- It is a severe and often fatal infection that requires prompt diagnosis and treatment 3, 4.
Causes and Risk Factors
- SBP is commonly caused by Gram-negative bacteria, but infections due to Gram-positive bacteria and multidrug-resistant bacteria are increasing 4.
- Risk factors for SBP include advanced liver disease, ascites, and certain medications such as acid suppressive and beta-adrenergic antagonist therapies 3.
Diagnosis
- Paracentesis is the diagnostic modality of choice for SBP, and an ascites absolute neutrophil count (ANC) ≥ 250 cells/mm3 is diagnostic of SBP 4, 5.
- Ascitic fluid should be placed in blood culture bottles to improve the culture yield, and leukocyte esterase reagent strips can be used for rapid diagnosis if available 4.
Treatment
- The treatment of choice for SBP is a third-generation cephalosporin, such as cefotaxime or ceftriaxone, administered for 5-10 days 2, 5, 6.
- Albumin infusion is associated with reduced risk of renal impairment and mortality, and should be considered as an adjunct to antibiotic therapy 2, 4.
- Specific patient populations may require more broad-spectrum coverage with a carbapenem or piperacillin-tazobactam 4.