• 👉 von Symptoms of HBV Clinical Presentation

Spontaneous bacterial peritonitis

(SBP; see “Ascites”; Hepatology 2021;74:1014)

• High mortality rate; risk factors include ascitic TP <1 g/dL, hx of SBP, current GIB

• Can p/w

  • encephalopathy,
  • abd pain,
  • fever,
  • but often (25%) asx; perform diagnostic paracentesis in all hospitalized patients with cirrhosis and ascites

• Micro:

  • typically, monobacterial GNRs (E. coli, Klebs) >GPCs (S. pneumo, enterococcus)

• Rx:

  • 3rd-gen. ceph is → 1st line;
  • consider pip/tazo or mero if ↑ risk of MDRO;
  • vanc if prior MRSA ⊕;
  • IV albumin 1.5 g/kg at ↣ time of dx & 1 g/kg on day 3 → ↑ survival (NEJM 1999;341:403)

• Repeat paracentesis at ↣ 48 h:

  • expect 25% ↓ in PMNs if Rx working.

• Indefinite Ppx if (1) h/o SBP or (2) ascitic TP <1.5 plus: Na ≤130 or Cr ≥1.2 or BUN ≥25 or [CPS ≥9 + Tbili ≥3] (Am J Gastro 2009;4:993) → cipro 500 mg qd or Bactrim DS qd. Short-term Ppx: CTX 1 g IV × 7d if GIB (Δ to cipro 500 bid/Bactrim DS bid when eating).