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Colon Ascendens Stent Peritonitis (CASP) - a Standardized Model for Polymicrobial Abdominal Sepsis
06:45

Colon Ascendens Stent Peritonitis (CASP) - a Standardized Model for Polymicrobial Abdominal Sepsis

Published on: December 18, 2010

[Spontaneous bacterial peritonitis]

Edna Strauss1, Wanda Regina Caly

  • 1Hospital de Clínicas da Universidade de São Paulo e Hemocentro-Fundação Pró-Sangue, São Paulo, SP. edna.strauss@hcnet.usp.br

Revista Da Sociedade Brasileira De Medicina Tropical
|March 31, 2004
PubMed

Insights

Spontaneous bacterial peritonitis (SBP) affects 30% of cirrhosis patients with ascites. Early diagnosis and antibiotics improve survival, but bacterial resistance necessitates new prophylactic strategies like probiotics.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Gastroenterology

Context:

  • Spontaneous bacterial peritonitis (SBP) is a serious complication in patients with cirrhosis and ascites, carrying high morbidity and mortality.
  • Pathogenesis involves impaired host defenses, microbial overgrowth, and bacterial translocation in end-stage liver disease.
  • Clinical presentation is variable, underscoring the need for ascitic fluid analysis.

Purpose:

  • To review the epidemiology, pathogenesis, diagnosis, treatment, and prevention of spontaneous bacterial peritonitis.
  • To highlight the impact of early diagnosis and antibiotic therapy on mortality rates.
  • To discuss emerging strategies for SBP prophylaxis, addressing bacterial resistance.

Summary:

  • SBP diagnosis relies on ascitic fluid neutrophil count (>250/mm³) and/or bacterial culture, with Enterobacteriaceae, particularly Escherichia coli, being common pathogens.
  • Intravenous third-generation cephalosporins demonstrate high efficacy (70-95%), and oral norfloxacin prevents recurrence.
  • Short-term antibiotic prophylaxis is advised post-gastrointestinal bleeding; probiotics show promise but require further research.

Impact:

  • Mortality from SBP has significantly decreased due to advancements in diagnosis and treatment.
  • Effective antibiotic regimens and prophylactic strategies are crucial for managing SBP in cirrhosis patients.
  • Ongoing research into novel prophylactic agents like probiotics is essential to combat rising antibiotic resistance.

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