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 bacterascitesTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- 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.
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- 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.
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- 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.