Spontaneous Bacterial Peritonitis (SBP) Flashcards
what is Spontaneous Bacterial Peritonitis (SBP)?
Ascitic fluid infection with no evidence of surgically treatable source (hence, “spontaneous”)
Vast majority of patients that have Spontaneous Bacterial Peritonitis (SBP) have what?
advanced cirrhosis
what are some risk factors (often associated with liver disease) for infection if SBP?
(5)
- Ascitic fluid total protein <1 g/dL. –> Low protein count
- Past episodes of SBP
- Serum total bilirubin >2.5 mg/dL –>High bilirubin
- Variceal hemorrhage
- PPI use –>changes pH and makes it easier for certain organisms to outperform others
SBP: Pathogenesis
- Liver disease (cirrhosis) predisposes to bacterial overgrowth and increased intestinal permeability
- Bacteria within gut can traverse intestinal wall and colonize mesenteric lymph nodes (translocation)
- Bacterascites can occur with lymphatic rupture (high pressure due to portal hypertension)
What organisms cause SBP?
- Most organisms are gram negatives (E.coli, klebsiella, pseudomonas, enterbacteriaceae) and some gram positive (streptococcus, staphylococcus)
should we use broad spectrum abs to treat SBP?
yes We need broad spectrum abx to cover this because it can be caused by gram negatives and gram positives.
what are some Clinical Manifestations of SBP? (7)
- fever
- abdominal pain
- AMS
- diarrhea
- paralytic ileus
- hypotension
- hypothermia
what are the 2 most common manifestations of SBP?
fever and abdominal pain, fever can be low grade.
Some patients with SBP are asymptomatic and are detected when they undergo _______ for another reason
paracentesis
SBP is almost always associated with ______
chronic liver disease
what 2 things do you need for a Definitive diagnosis is SBP?
o Positive ascitic fluid culture
o Elevated ascitic fluid absolute PMN count >250 cells/mm3
When should you treat SBP empirically? (4)
o T >37.8°C (100°F)í this is considered a fever in chronic liver disease pts
o Abdominal pain and/or tenderness
o Change in mental status
o Ascitic fluid PMN count >250 cells/mm3
if they have any of these go ahead and treat
if you are treating empirically for SBP, it is important that you still obtain what?
ascitic fluid for culture
Up to date antibiotic choice for treating SBP
Cefotaxime (Claforan) IV
if they are pen allergic use:
levofloxacin (Levaquin) IV
according to the Sanford Guide 2017, what antibiotics should you use to treat Community-acquired SBP?
Piperacillin-tazobactam (Zosyn) IV or ceftriaxone IV
if they are pen allergic use:
ciprofloxacin IV
according to the Sanford Guide 2017, what antibiotics should you use to treat Nosocomial SBP?
Meropenem (carbopenem) IV or Daptomycin IV
what is the length of Length of Antibiotic Therapy for SBP?
Minimum 5 days and stop if clinical improvement (is often significant)
If fever or pain persists, repeat paracentesis, What should you do if PMN <250?
STOP tx
If fever or pain persists, repeat paracentesis, what should you do if PMN is greater than pretreatment value?
look for surgical source
If fever or pain persists, repeat paracentesis, what should you do if PMN is elevated but less than pretreatment?
continue antibiotics x 48 hours and repeat paracentesis
what should you permanently discontinue if a pt has SBP?
nonselective beta blockers
why should you stop BB in patients with SBP
o Higher mortality rates
o Increase rate of hepatorenal syndrome
o Longer length of hospital stays
o Decreasing cardiac output can worsen the conditions of pts with SBP and chronic cirrhosis
what can you give to a patient with SBP to help reduce the risk of renal failure?
Albumin IV
when can we use Albumin IV in a SBP pt?
- Creatinine >1 mg/dL
- BUN >30 mg/dL
- Total bilirubin >4 mg/dL
