Spontaneous Bacterial Peritonitis

Question 1

SBP definition

Answer 1

bacterial infection of the ascitic fluid of the peritoneum

Question 2

What organisms usually SBP

Answer 2

Enteric gram negatives (e.coli, K.pneumonia)

Question 3

Frequent cause of death for cirrhotic patients

Answer 3

SBP

Question 4

Diagnosing SBP

Answer 4

Signs and symptoms
Paracentesis show absolute PMN ≥250

Question 5

Signs and symptoms of SBP

Answer 5

fever, malaise, weakness
elevated WBC
abdominal pain, tenderness

Question 6

Absolute polymorphonucleated leukocyte calculation

Answer 6

WBC in ascitic fluid x %PMN

Question 7

Why don’t we wait for bacterial culture results before treating?

Answer 7

Takes 72 hours for results

Question 8

How soon can we get the APMN WBC count?

Answer 8

same day

Question 9

Treatment of SBP - active infection

Answer 9

Empiric antibiotic: 3rd gen cephalosporin x 5 days
- if allergy, use ciprofloxacin
- Once culture results out: pathogen-directed therapy

IV albumin for patients that qualify
1.5 g/kg on day 1
1 g/kg on day 3

Question 10

What patients qualify for IV albumin in SBP?

Answer 10

Any one of the following
SCr>1
Bilirubin > 4
BUN > 30

Question 11

After starting antibiotics, how soon do you repeat a paracentesis?

Answer 11

48 hours after starting abx
- check for ESBL
- may need to escalate therapy
- check if at goal

Question 12

What is the goal of abx therapy in SBP?

Answer 12

Drop PMW >25% from baseline
if not at goal, broaden coverage
- ESBL? –>use carbapenems
Reset day count, 5 days of the new drug

Question 13

SBP treatment – prophylaxis

Answer 13

For anyone with acute variceal bleeding, and especially after SBP
7 days of IV ceftriaxone or cipro if allergic