Update Review Article: Spontaneous Bacterial Peritonitis

Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication in cirrhotic patients with ascites. To describe spontaneous bacterial peritonitis (SBP) in the context of currently accepted criteria for diagnosis, treatment and prevention. A review of SBP and its associated etiopathogenic factors is presented. Numerous studies on mechanisms of disease, bacteriology, epidemiology, diagnostic markers, and current guidelines for its diagnosis, treatment and prevention are discussed. Peritonitis in patients with ascites in the absence of secondary causes, such as perforation of a viscus, occurs primarily in patients with end-stage liver disease. Enteric organisms, mainly gram-negative bacilli, probably translocate to regional lymph nodes to produce bacteremia and seeding of ascitic fluid. Signs and symptoms of peritonitis are usually subtle. The ascitic fluid polymorphonuclear leukocyte count is the best determinant for early diagnosis and treatment of SBP. Third-generation cephalosporins such as cefotaxime are considered the drugs of choice for treatment, whereas quinolones such as norfloxacin are used to decrease recurrence. Despite increased awareness, early diagnosis, and prompt and effective antimicrobial therapy, SBP recurs frequently and is associated with a high mortality rate. Patients with SBP should be assessed for candidacy for liver transplantation. Keyword: Spontaneous bacterial peritonitis, Bacteriology, Epidemiology, Diagnostic markers, Cephalosporin