spontaneous bacterial peritonitis

spontaneous bacterial peritonitis

Spontaneous peritonitis Critical care A severe acute infection of the peritoneum that accompanies end-stage liver disease and ascites Agents E coli, Klebsiella spp, S pneumoniae, Enterococcus faecalis Clinical Abdominal pain, ascites, chills, encephalopathy, fever, rebound tenderness Lab Ascitic fluid has > 500–often 10,000+ PMNs/mm3, protein > 1.0 g/dL, monomicrobials; 40% are culture-negative Risk factors Cirrhosis, nephrotic syndrome, peptic ulcer disease, appendicitis, diverticulitis Treatment 3^rd-generation cephalosporins–eg, cefotaxime, + IV albumin Mortality 30-40%, less if treated early, worse if accompanied by signs of poor liver function–eg, upper GI bleeding, BR > 8 mg/dL, serum albumin < 2.5 g/dL, hepatic encephalopathy, hepatorenal syndrome. See Peritonitis.