Spontaneous bacterial peritonitis classification: Difference between revisions

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__NOTOC__
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{{Spontaneous bacterial peritonitis}}
{{Spontaneous bacterial peritonitis}}
{{CMG}} ; {{AE}} {{ADI}} {{SCh}}
{{CMG}} ; {{AE}} {{ADI}} {{SCh}} {{AY}}
 
==Overview==
==Overview==
[[Spontaneous bacterial peritonitis]] is one variant of ascitic fluid infections.<ref name="pmid15920324">{{cite journal| author=Sheer TA, Runyon BA| title=Spontaneous bacterial peritonitis. | journal=Dig Dis | year= 2005 | volume= 23 | issue= 1 | pages= 39-46 | pmid=15920324 | doi=10.1159/000084724 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15920324  }} </ref> Classification of ascitic fluid infections is based on [[neutrophil]] count and culture report.<ref name="pmid25819304">Dever JB, Sheikh MY (2015) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=25819304 Review article: spontaneous bacterial peritonitis--bacteriology, diagnosis, treatment, risk factors and prevention.] ''Aliment Pharmacol Ther'' 41 (11):1116-31. [http://dx.doi.org/10.1111/apt.13172 DOI:10.1111/apt.13172] PMID: [https://pubmed.gov/25819304 25819304]</ref><ref name="pmid19475696">{{cite journal| author=Runyon BA, AASLD Practice Guidelines Committee| title=Management of adult patients with ascites due to cirrhosis: an update. | journal=Hepatology | year= 2009 | volume= 49 | issue= 6 | pages= 2087-107 | pmid=19475696 | doi=10.1002/hep.22853 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19475696  }} </ref> Asymptomatic bacterascites is usually the transient residence of bacteria in ascitic fluid without clinical features of [[peritonitis]] or increased ascitic fluid [[polymorphonuclear cells]].<ref name="pmid2066060">{{cite journal| author=Pelletier G, Lesur G, Ink O, Hagege H, Attali P, Buffet C et al.| title=Asymptomatic bacterascites: is it spontaneous bacterial peritonitis? | journal=Hepatology | year= 1991 | volume= 14 | issue= 1 | pages= 112-5 | pmid=2066060 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2066060  }} </ref> SBP is also classified based on the routes of infection and the clinical setting as follows [[health care]]-associated, [[nosocomial]], community acquired, [[multi-drug resistant]] and recurrent.
[[Spontaneous bacterial peritonitis]] is one variant of [[Ascites|ascitic fluid]] [[infections]].<ref name="pmid15920324">{{cite journal| author=Sheer TA, Runyon BA| title=Spontaneous bacterial peritonitis. | journal=Dig Dis | year= 2005 | volume= 23 | issue= 1 | pages= 39-46 | pmid=15920324 | doi=10.1159/000084724 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15920324  }} </ref> Classification of ascitic fluid infections is based on [[neutrophil]] count and [[Growth medium|culture]] report.<ref name="pmid25819304">Dever JB, Sheikh MY (2015) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=25819304 Review article: spontaneous bacterial peritonitis--bacteriology, diagnosis, treatment, risk factors and prevention.] ''Aliment Pharmacol Ther'' 41 (11):1116-31. [http://dx.doi.org/10.1111/apt.13172 DOI:10.1111/apt.13172] PMID: [https://pubmed.gov/25819304 25819304]</ref><ref name="pmid19475696">{{cite journal| author=Runyon BA, AASLD Practice Guidelines Committee| title=Management of adult patients with ascites due to cirrhosis: an update. | journal=Hepatology | year= 2009 | volume= 49 | issue= 6 | pages= 2087-107 | pmid=19475696 | doi=10.1002/hep.22853 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19475696  }} </ref> Asymptomatic bacterascites is usually the transient residence of bacteria in ascitic fluid without clinical features of [[peritonitis]] or increased [[Ascites|ascitic fluid]] [[polymorphonuclear cells]].<ref name="pmid2066060">{{cite journal| author=Pelletier G, Lesur G, Ink O, Hagege H, Attali P, Buffet C et al.| title=Asymptomatic bacterascites: is it spontaneous bacterial peritonitis? | journal=Hepatology | year= 1991 | volume= 14 | issue= 1 | pages= 112-5 | pmid=2066060 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2066060  }} </ref> SBP is also classified based on the routes of [[infection]] and the clinical setting as follows [[health care]]-associated, [[nosocomial]], community acquired, [[multi-drug resistant]] and recurrent.


==Classification==
==Classification==
* Spontaneous bacterial [[peritonitis]] is one of the variants of ascitic fluid infections.<ref name="pmid15920324">{{cite journal| author=Sheer TA, Runyon BA| title=Spontaneous bacterial peritonitis. | journal=Dig Dis | year= 2005 | volume= 23 | issue= 1 | pages= 39-46 | pmid=15920324 | doi=10.1159/000084724 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15920324  }} </ref>
* [[SBP|Spontaneous bacterial peritonitis]] is one of the variants of [[Ascites|ascitic fluid]] [[Infection|infections]].<ref name="pmid15920324">{{cite journal| author=Sheer TA, Runyon BA| title=Spontaneous bacterial peritonitis. | journal=Dig Dis | year= 2005 | volume= 23 | issue= 1 | pages= 39-46 | pmid=15920324 | doi=10.1159/000084724 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15920324  }} </ref>
* Classification of ascitic fluid infections is based on [[neutrophil]] count and culture report.<ref name="pmid25819304">Dever JB, Sheikh MY (2015) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=25819304 Review article: spontaneous bacterial peritonitis--bacteriology, diagnosis, treatment, risk factors and prevention.] ''Aliment Pharmacol Ther'' 41 (11):1116-31. [http://dx.doi.org/10.1111/apt.13172 DOI:10.1111/apt.13172] PMID: [https://pubmed.gov/25819304 25819304]</ref><ref name="pmid19475696">{{cite journal| author=Runyon BA, AASLD Practice Guidelines Committee| title=Management of adult patients with ascites due to cirrhosis: an update. | journal=Hepatology | year= 2009 | volume= 49 | issue= 6 | pages= 2087-107 | pmid=19475696 | doi=10.1002/hep.22853 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19475696  }} </ref>
* Classification of [[Ascites|ascitic fluid]] infections is based on [[Neutrophil|neutrophil count]] and [[Culture medium|culture]] report.<ref name="pmid25819304">Dever JB, Sheikh MY (2015) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=25819304 Review article: spontaneous bacterial peritonitis--bacteriology, diagnosis, treatment, risk factors and prevention.] ''Aliment Pharmacol Ther'' 41 (11):1116-31. [http://dx.doi.org/10.1111/apt.13172 DOI:10.1111/apt.13172] PMID: [https://pubmed.gov/25819304 25819304]</ref><ref name="pmid19475696">{{cite journal| author=Runyon BA, AASLD Practice Guidelines Committee| title=Management of adult patients with ascites due to cirrhosis: an update. | journal=Hepatology | year= 2009 | volume= 49 | issue= 6 | pages= 2087-107 | pmid=19475696 | doi=10.1002/hep.22853 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19475696  }} </ref>
* Asymptomatic bacterascites is usually the transient residence of bacteria in ascitic fluid without clinical features of  [[peritonitis]] or increased ascitic fluid polymorphonuclear cells.<ref name="pmid2066060">{{cite journal| author=Pelletier G, Lesur G, Ink O, Hagege H, Attali P, Buffet C et al.| title=Asymptomatic bacterascites: is it spontaneous bacterial peritonitis? | journal=Hepatology | year= 1991 | volume= 14 | issue= 1 | pages= 112-5 | pmid=2066060 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2066060  }} </ref>
* [[Asymptomatic]] bacterascites is usually the transient residence of bacteria in [[Ascites|ascitic]] fluid without clinical features of  [[peritonitis]] or increased [[Ascites|ascitic fluid]] [[polymorphonuclear cells]].<ref name="pmid2066060">{{cite journal| author=Pelletier G, Lesur G, Ink O, Hagege H, Attali P, Buffet C et al.| title=Asymptomatic bacterascites: is it spontaneous bacterial peritonitis? | journal=Hepatology | year= 1991 | volume= 14 | issue= 1 | pages= 112-5 | pmid=2066060 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2066060  }} </ref>


{|  
{|  
|-style="background:silver; color:black"
! '''Type of Infection''' !! '''Bacterial Culture Report''' !! '''Ascitic fluid analysis [[Neutrophil]] Count (cells/mm<sup>3</sup>)''' !! '''Clinical pearls''' !!
|-style="background:silver; color:black"
|align=center| Spontaneous bacterial [[peritonitis]]<ref name="pmid19845823">{{cite journal| author=Kim SU, Kim DY, Lee CK, Park JY, Kim SH, Kim HM et al.| title=Ascitic fluid infection in patients with [[hepatitis B]] virus-related liver [[cirrhosis]]: culture-negative neutrocytic ascites versus spontaneous bacterial [[peritonitis]]. | journal=J Gastroenterol Hepatol | year= 2010 | volume= 25 | issue= 1 | pages= 122-8 | pmid=19845823 | doi=10.1111/j.1440-1746.2009.05970.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19845823  }} </ref> ||align=center| Positive usually for one organism || align=center|≥250 ||Patients with cirrhosis and ascites in the presence or absence of symptoms and signs
|- style="background:silver; color:black"
|- style="background:silver; color:black"
|align=center| Culture negative neutrocytic ascites (CNNA)<ref name="pmid2365982">{{cite journal| author=Pelletier G, Salmon D, Ink O, Hannoun S, Attali P, Buffet C et al.| title=Culture-negative neutrocytic ascites: a less severe variant of spontaneous bacterial peritonitis. | journal=J Hepatol | year= 1990 | volume= 10 | issue= 3 | pages= 327-31 | pmid=2365982 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2365982  }} </ref><ref name="pmid6500513">{{cite journal| author=Runyon BA, Hoefs JC| title=Culture-negative neutrocytic ascites: a variant of spontaneous bacterial peritonitis. | journal=Hepatology | year= 1984 | volume= 4 | issue= 6 | pages= 1209-11 | pmid=6500513 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6500513 }} </ref>||align=center| Negative ||align=center| ≥250 || Poor culture technique and prior antibiotics or low opsonic activity in ascitic fluid. Commonly encountered phenotype and requires antibiotic therapy.
! '''Type of [[Infection]]''' !! '''[[Growth medium|Bacterial Culture]] Report''' !! '''[[Ascitic|Ascitic fluid analysis]] [[Neutrophil]] Count (cells/mm<sup>3</sup>)''' !! '''Clinical aspects''' !!
|- style="background:silver; color:black"
| align="center" | [[SBP|Spontaneous bacterial peritonitis]]<ref name="pmid19845823">{{cite journal| author=Kim SU, Kim DY, Lee CK, Park JY, Kim SH, Kim HM et al.| title=Ascitic fluid infection in patients with [[hepatitis B]] virus-related liver [[cirrhosis]]: culture-negative neutrocytic ascites versus spontaneous bacterial [[peritonitis]]. | journal=J Gastroenterol Hepatol | year= 2010 | volume= 25 | issue= 1 | pages= 122-8 | pmid=19845823 | doi=10.1111/j.1440-1746.2009.05970.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19845823 }} </ref> || align="center" | Positive usually for one [[organism]] || align="center" |≥250 ||Patients with [[cirrhosis]] and [[ascites]] in the presence or absence of symptoms and signs
|- style="background:silver; color:black"
|- style="background:silver; color:black"
|align=center| Monomicrobial bacterascites<ref name="pmid2210672">{{cite journal| author=Runyon BA| title=Monomicrobial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis. | journal=Hepatology | year= 1990 | volume= 12 | issue= 4 Pt 1 | pages= 710-5 | pmid=2210672 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2210672 }} </ref> ||align=center| Positive for one organism ||align=center| <250 || Ascitic fluid infection which may resolve spontaneously or progress to SBP. Mortality is similar to SBP and should be treated as SBP.
| align="center" | Culture negative neutrocytic ascites (CNNA)<ref name="pmid2365982">{{cite journal| author=Pelletier G, Salmon D, Ink O, Hannoun S, Attali P, Buffet C et al.| title=Culture-negative neutrocytic ascites: a less severe variant of spontaneous bacterial peritonitis. | journal=J Hepatol | year= 1990 | volume= 10 | issue= 3 | pages= 327-31 | pmid=2365982 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2365982  }} </ref><ref name="pmid6500513">{{cite journal| author=Runyon BA, Hoefs JC| title=Culture-negative neutrocytic ascites: a variant of spontaneous bacterial peritonitis. | journal=Hepatology | year= 1984 | volume= 4 | issue= 6 | pages= 1209-11 | pmid=6500513 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6500513 }} </ref>|| align="center" | Negative || align="center" | ≥250 || Poor [[Growth medium|culture]] technique and prior [[Antibiotic|antibiotics]] or low [[Opsonin|opsonic]] activity in ascitic fluid. Commonly encountered [[phenotype]] and requires [[antibiotic therapy]].
|- style="background:silver; color:black"
|- style="background:silver; color:black"
|align=center| Secondary bacterial [[peritonitis]] ||align=center| Positive for many microbes ||align=center| ≥250 || Intraperitoneal source of infection e.g. [[diverticulitis]]
| align="center" | Monomicrobial bacterascites<ref name="pmid2210672">{{cite journal| author=Runyon BA| title=Monomicrobial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis. | journal=Hepatology | year= 1990 | volume= 12 | issue= 4 Pt 1 | pages= 710-5 | pmid=2210672 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2210672  }} </ref> || align="center" | Positive for one organism || align="center" | <250 || Ascitic fluid infection which may resolve spontaneously or progress to SBP. [[Mortality]] is similar to SBP and should be treated as SBP.
|- style="background:silver; color:black"
|- style="background:silver; color:black"
|align=center| Polymicrobial bacterascites<ref name="pmid3778046">{{cite journal| author=Runyon BA, Hoefs JC, Canawati HN| title=Polymicrobial bacterascites. A unique entity in the spectrum of infected ascitic fluid. | journal=Arch Intern Med | year= 1986 | volume= 146 | issue= 11 | pages= 2173-5 | pmid=3778046 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3778046  }} </ref> ||align=center| Positive for many microbes ||align=center| <250 || Usually due to bowel perforation by the [[paracentesis]] needle and reflects growth of gut flora before the ascitic fluid can mount a neutrocytic response.
| align="center" | Secondary bacterial [[peritonitis]] || align="center" | Positive for many microbes || align="center" | ≥250 || [[Intraperitoneal]] source of infection e.g. [[diverticulitis]]
|- style="background:silver; color:black"
| align="center" | Polymicrobial bacterascites<ref name="pmid3778046">{{cite journal| author=Runyon BA, Hoefs JC, Canawati HN| title=Polymicrobial bacterascites. A unique entity in the spectrum of infected ascitic fluid. | journal=Arch Intern Med | year= 1986 | volume= 146 | issue= 11 | pages= 2173-5 | pmid=3778046 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3778046  }} </ref> || align="center" | Positive for many microbes || align="center" | <250 || Usually due to [[bowel perforation]] by the [[paracentesis]] needle and reflects growth of [[gut flora]] before the ascitic fluid can mount a neutrocytic response.
|}
|}
=== Classification Based on Clinical Setting ===
=== Classification Based on Clinical Setting ===
Based on the route of infection SBP is classified as follows:<ref name="pmid25819304">Dever JB, Sheikh MY (2015) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=25819304 Review article: spontaneous bacterial peritonitis--bacteriology, diagnosis, treatment, risk factors and prevention.] ''Aliment Pharmacol Ther'' 41 (11):1116-31. [http://dx.doi.org/10.1111/apt.13172 DOI:10.1111/apt.13172] PMID: [https://pubmed.gov/25819304 25819304]</ref><ref name="Fernández2002">{{cite journal|last1=Fernández|first1=J|title=Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis|journal=Hepatology|volume=35|issue=1|year=2002|pages=140–148|issn=02709139|doi=10.1053/jhep.2002.30082}}</ref>
Based on the route of infection SBP is classified as follows:<ref name="pmid25819304">Dever JB, Sheikh MY (2015) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=25819304 Review article: spontaneous bacterial peritonitis--bacteriology, diagnosis, treatment, risk factors and prevention.] ''Aliment Pharmacol Ther'' 41 (11):1116-31. [http://dx.doi.org/10.1111/apt.13172 DOI:10.1111/apt.13172] PMID: [https://pubmed.gov/25819304 25819304]</ref><ref name="Fernández2002">{{cite journal|last1=Fernández|first1=J|title=Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis|journal=Hepatology|volume=35|issue=1|year=2002|pages=140–148|issn=02709139|doi=10.1053/jhep.2002.30082}}</ref>


{| border="2" cellpadding="4" cellspacing="0" style="margin: 1em 1em 1em 0; background: #f9f9f9; border: 1px #aaa solid; border-collapse: collapse;" width="75%"
{| style="margin: 1em 1em 1em 0; background: #f9f9f9; border: 1px #aaa solid; border-collapse: collapse;" width="75%" cellspacing="0" cellpadding="4" border="2"
! '''Clinical setting associated with SBP''' !! Criteria
! '''Clinical setting associated with SBP''' !! Criteria
|-
|-
| '''Health care-associated SBP (HCA)'''
| '''Health care-associated SBP (HCA)'''
|
|
* Diagnosis of [[peritonitis]] within 48 hours of hospital admission in patients with any prior health care contact in the past 90 days (e.g. recent hospitalisation, nursing home, [[dialysis]] centers and other health care setting).
* Diagnosis of [[peritonitis]] within 48 hours of hospital admission in patients with any prior health care contact in the past 90 days (e.g. recent hospitalisation, nursing home, [[dialysis]] centers and other health care setting)
|-
|-
| '''[[Nosocomial]] SBP'''
| '''[[Nosocomial|Nosocomial SBP]]'''
|
|
* Diagnosis of [[peritonitis]] 48 hours after the hospital admission. Predominantly caused by [[gram-positive]] cocci.
* Diagnosis of [[peritonitis]] 48 hours after the hospital admission.
* Predominantly caused by [[gram-positive cocci]]
|-
|-
| '''Community acquired SBP (CA)'''
| '''Community acquired SBP (CA)'''
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| '''[[Multi-drug resistant]] SBP'''
| '''[[Multi-drug resistant]] SBP'''
|
|
* Associated with prior history of antibiotic exposure. Treatment of [[peritonitis]] is based on culture sensitivity.
* Associated with prior history of [[antibiotic]] exposure. Treatment of [[peritonitis]] is based on [[Culture medium|culture]][[sensitivity|sandensitivity]]
|-
|-
| '''Recurrent SBP'''
| '''Recurrent SBP'''
|
|
* Recurrent episodes of peritonitis increases risk of mortality compared to first episode mortality of SBP. Prophylactic antibiotics can reduce the mortality.
* Recurrent episodes of peritonitis increases risk of [[Mortality rate|mortality]] compared to first episode mortality of SBP
* [[Antibiotics|Prophylactic antibiotics]] can reduce the mortality
|}<br clear="left" />
|}<br clear="left" />


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Shivani Chaparala M.B.B.S [3] Ahmed Younes M.B.B.CH [4]

Overview

Spontaneous bacterial peritonitis is one variant of ascitic fluid infections.[1] Classification of ascitic fluid infections is based on neutrophil count and culture report.[2][3] Asymptomatic bacterascites is usually the transient residence of bacteria in ascitic fluid without clinical features of peritonitis or increased ascitic fluid polymorphonuclear cells.[4] SBP is also classified based on the routes of infection and the clinical setting as follows health care-associated, nosocomial, community acquired, multi-drug resistant and recurrent.

Classification

Type of Infection Bacterial Culture Report Ascitic fluid analysis Neutrophil Count (cells/mm3) Clinical aspects
Spontaneous bacterial peritonitis[5] Positive usually for one organism ≥250 Patients with cirrhosis and ascites in the presence or absence of symptoms and signs
Culture negative neutrocytic ascites (CNNA)[6][7] Negative ≥250 Poor culture technique and prior antibiotics or low opsonic activity in ascitic fluid. Commonly encountered phenotype and requires antibiotic therapy.
Monomicrobial bacterascites[8] Positive for one organism <250 Ascitic fluid infection which may resolve spontaneously or progress to SBP. Mortality is similar to SBP and should be treated as SBP.
Secondary bacterial peritonitis Positive for many microbes ≥250 Intraperitoneal source of infection e.g. diverticulitis
Polymicrobial bacterascites[9] Positive for many microbes <250 Usually due to bowel perforation by the paracentesis needle and reflects growth of gut flora before the ascitic fluid can mount a neutrocytic response.

Classification Based on Clinical Setting

Based on the route of infection SBP is classified as follows:[2][10]

Clinical setting associated with SBP Criteria
Health care-associated SBP (HCA)
  • Diagnosis of peritonitis within 48 hours of hospital admission in patients with any prior health care contact in the past 90 days (e.g. recent hospitalisation, nursing home, dialysis centers and other health care setting)
Nosocomial SBP
Community acquired SBP (CA)
  • Diagnosis of peritonitis within 48 hours of hospital admission, but no history of prior health care contact in the past 90 days. Predominantly caused by gram-negative bacteria.
Multi-drug resistant SBP
Recurrent SBP


References

  1. 1.0 1.1 Sheer TA, Runyon BA (2005). "Spontaneous bacterial peritonitis". Dig Dis. 23 (1): 39–46. doi:10.1159/000084724. PMID 15920324.
  2. 2.0 2.1 2.2 Dever JB, Sheikh MY (2015) Review article: spontaneous bacterial peritonitis--bacteriology, diagnosis, treatment, risk factors and prevention. Aliment Pharmacol Ther 41 (11):1116-31. DOI:10.1111/apt.13172 PMID: 25819304
  3. 3.0 3.1 Runyon BA, AASLD Practice Guidelines Committee (2009). "Management of adult patients with ascites due to cirrhosis: an update". Hepatology. 49 (6): 2087–107. doi:10.1002/hep.22853. PMID 19475696.
  4. 4.0 4.1 Pelletier G, Lesur G, Ink O, Hagege H, Attali P, Buffet C; et al. (1991). "Asymptomatic bacterascites: is it spontaneous bacterial peritonitis?". Hepatology. 14 (1): 112–5. PMID 2066060.
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