Quick Tips: Spontaneous Bacterial Peritonitis

Hersh Shroff

Thanks to LFN's Quick Tips series, you've got ascites down pat.

Now it's time to tackle spontaneous bacterial peritonitis (SBP). Enjoy!

Links to the referenced articles

Fernandez J, et al. Hepatology 2002 - changing microbiology of SBP

Fernandez J, et al. Gut 2018 - prevalence of bacterial infections (and SBP) in acute-on-chronic liver failure

Evans LT, et al. Hepatology 2003 - prevalence of asymptomatic SBP in outpatients

Chinnock B, et al. J Emerg Med 2013 - just having a low "clinical impression" for SBP is not good enough! Patients can be asymptomatic!

Runyon BA, et al. Hepatology 1984 - Bruce Runyon's description of culture-negative neutrocytic ascites.

Gaetano JN, et al. J Gastroenterol Hepatol 2016 - importance of paracentesis on hospitalized patients

Rosenblatt R, et al. Am J Gastroenterol 2019 - differences in outcomes whether paracentesis is performed "early" or "late" on admission 

Runyon BA, et al. Gastroenterology 1991 - comparing 5-day vs. 10-day courses of antibiotics in treatment of SBP

Sort P, et al. NEJM 1999 - trial demonstrating the benefit of albumin on reducing HRS, mortality in patients with SBP

Sigal SH, et al. Gut 2007 - small trial suggesting that "low-risk" patients with SBP may not actually need albumin

Mandorfer M, et al. Gastroenterology 2014 - study demonstrating the detrimental effects of B-blockers during treatment of SBP

Dam G, et al. Hepatology 2016 - study demonstrating that PPI use may increase the risk of SBP

Runyon BA, et al. Gastroenterology 1989 - demonstrating that diuresis (compared to paracentesis) increases ascitic fluid opsonins and serum complements, possibly protecting against SBP

Bernard B, et al. Hepatology 1999 - meta-analysis demonstrating the benefit of antibiotic prophylaxis in patients with GI bleeding

Fernandez J, et al. Gastroenterology 2007 - RCT showing the benefit of primary prophylaxis in select patients with low ascitic fluid protein

Runyon BA. Gastroenterology 1986 - Bruce Runyon describes that low ascitic fluid protein (<1.0) predisposes to SBP

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