Spontaneous bacterial peritonitis variants
- Bruce A Runyon, MD
Bruce A Runyon, MD
- Section Editor — Cirrhosis and Its Complications
- Clinical Professor of Medicine
- University of New Mexico, Division of Gastroenterology and Hepatology
- Special Hepatology Consultant to the Indian Health Service
- Northern Navajo Medical Center, Shiprock, New Mexico
Spontaneous bacterial peritonitis (SBP) is defined as an ascitic fluid infection without an evident intraabdominal surgically treatable source; it primarily occurs in patients with advanced cirrhosis [1,2]. The diagnosis is established by a positive ascitic fluid bacterial culture and an elevated ascitic fluid absolute polymorphonuclear leukocyte (PMN) count (≥250 cells/mm3).
When faced with a patient who appears to have spontaneous bacterial peritonitis (SBP), the clinician should at least consider the possibility that the patient might have a surgically treatable source for the infection (eg, a ruptured peptic ulcer) (see "Spontaneous bacterial peritonitis in adults: Diagnosis"). This distinction is crucial because the mortality of secondary bacterial peritonitis in the presence of ascites approaches 100 percent, if treated only with antibiotics with no surgical intervention . Conversely, if a patient with SBP receives an unnecessary exploratory laparotomy, the mortality is approximately 80 percent . With appropriate antibiotic treatment of SBP, infection-related mortality approaches zero . (See "Spontaneous bacterial peritonitis in adults: Treatment and prophylaxis".)
●Culture-negative neutrocytic ascites
●Monomicrobial non-neutrocytic bacterascites
- Akriviadis EA, Runyon BA. Utility of an algorithm in differentiating spontaneous from secondary bacterial peritonitis. Gastroenterology 1990; 98:127.
- Runyon BA, AASLD Practice Guidelines Committee. Management of adult patients with ascites due to cirrhosis: an update. Hepatology 2009; 49:2087.
- Garrison RN, Cryer HM, Howard DA, Polk HC Jr. Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis. Ann Surg 1984; 199:648.
- Runyon BA, McHutchison JG, Antillon MR, et al. Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis. A randomized controlled study of 100 patients. Gastroenterology 1991; 100:1737.
- Sheer TA, Runyon BA. Spontaneous bacterial peritonitis. Dig Dis 2005; 23:39.
- Runyon BA, Hoefs JC. Culture-negative neutrocytic ascites: a variant of spontaneous bacterial peritonitis. Hepatology 1984; 4:1209.
- Hillebrand DJ, Runyon BA, Yasmineh WG, Rynders GP. Ascitic fluid adenosine deaminase insensitivity in detecting tuberculous peritonitis in the United States. Hepatology 1996; 24:1408.
- Runyon BA, Hoefs JC, Morgan TR. Ascitic fluid analysis in malignancy-related ascites. Hepatology 1988; 8:1104.
- Hoefs JC. Increase in ascites white blood cell and protein concentrations during diuresis in patients with chronic liver disease. Hepatology 1981; 1:249.
- Runyon BA, Canawati HN, Akriviadis EA. Optimization of ascitic fluid culture technique. Gastroenterology 1988; 95:1351.
- McHutchison JG, Runyon BA. Spontaneous bacterial peritonitis. In: Gastrointestinal and Hepatic Infections, Surawicz CM, Owen RL (Eds), WB Saunders, Philadelphia 1994. p.455.
- Evans LT, Kim WR, Poterucha JJ, Kamath PS. Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites. Hepatology 2003; 37:897.
- Pelletier G, Salmon D, Ink O, et al. Culture-negative neutrocytic ascites: a less severe variant of spontaneous bacterial peritonitis. J Hepatol 1990; 10:327.
- Kim SU, Kim DY, Lee CK, et al. Ascitic fluid infection in patients with hepatitis B virus-related liver cirrhosis: culture-negative neutrocytic ascites versus spontaneous bacterial peritonitis. J Gastroenterol Hepatol 2010; 25:122.
- Antillon MR, Runyon BA. Effect of marked peripheral leukocytosis on the leukocyte count in ascites. Arch Intern Med 1991; 151:509.
- Runyon BA. Monomicrobial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis. Hepatology 1990; 12:710.
- Pelletier G, Lesur G, Ink O, et al. Asymptomatic bacterascites: is it spontaneous bacterial peritonitis? Hepatology 1991; 14:112.
- Runyon BA, Hoefs JC, Canawati HN. Polymicrobial bacterascites. A unique entity in the spectrum of infected ascitic fluid. Arch Intern Med 1986; 146:2173.