Daily Bolus of LR: Spontaneous Bacterial Peritonitis

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May 2, 2011 by dailybolusoflr

Spontaneous Bacterial Peritonitis


Some key points below. . .


·         Should be considered in all patients with ascites who have abdominal pain, fever, altered mental status, hypotension, new onset renal failure

·         Higher risk patients are those with GI bleeding, low protein ascitic fluid, advanced cirrhosis states

·         A small percentage of patients will be asymptomatic

·         Over 90% of patients will have a single organism as the etiology and up to 50% will be E. coli.  The most common group of organisms are gram negatives

·         Higher sensitivies from culture of ascitic fluid are found when at least 10 cc of fluid is placed directly in standard commercially available blood culture bottles

·         Diagnosis is based off of evaluation of ascitic fluid and is considered positive when the PMN count is > 250 cells/uL

·         Patients with PMN counts < 250 cells/uL but with positive gram stains/cultures should be treated for SBP if there is clinical suspicion for the disease process (ie. not in asymptomatic patients)

·         Treatment is typically an extended spectrum 3rd generation cephalosporin (like cefotaxime) or ampicillin/gentamicin (or other aminoglycoside) combination



Journal of Hepatology Volume 32, Issue 1, January 2000, Pages 142-153



Linda Regan, MD FACEP

Program Director, Emergency Medicine Residency

Johns Hopkins Medical Institutions


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