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[Spontaneous bacterial peritonitis]
M B Jacobsen1, A Bjøorneklett, E Schrumpf
1Medisinsk avdeling A, Rikshospitalet, Oslo.
Abstract:
We describe five patients with spontaneous bacterial peritonitis. The condition is reported more frequently than before and survival has improved. Important clinical features are increasing ascites and unexpected derangement of liver function. Possible predisposing factors, as well as diagnostic and therapeutic measures, are discussed. We emphasize the significance of ascitic polymorph nuclear cell count and bedside inoculation of ascites on blood culture medium, and stress the importance of prompt antibiotic therapy. The choice of empiric antimicrobial treatment is based on the reported frequency of causative agent and toxicity to drugs. Our experience so far indicates that cefotaxime administered as monotherapy is safe and efficient in these patients. Aminoglycosides should be avoided because of increased nephrotoxicity in patients with liver failure.
Insights
Spontaneous bacterial peritonitis (SBP) is increasingly diagnosed with improved survival. Key features include worsening ascites and liver function abnormalities, necessitating prompt antibiotic treatment.
Area of Science:
- Hepatology
- Infectious Diseases
Background:
- Spontaneous bacterial peritonitis (SBP) is a serious complication of advanced liver disease.
- Increasing reports suggest improved survival rates for SBP patients.
Observation:
- Five patients with SBP presented with worsening ascites and unexpected liver function derangement.
- Key diagnostic indicators include ascitic fluid polymorphonuclear cell count and blood culture inoculation.
Findings:
- Prompt antibiotic therapy is crucial for managing SBP.
- Cefotaxime monotherapy demonstrated safety and efficacy.
- Aminoglycosides should be avoided due to nephrotoxicity in liver failure patients.
Implications:
- Early diagnosis and appropriate antibiotic selection can improve SBP patient outcomes.
- Understanding predisposing factors and diagnostic markers aids in clinical management.
- This study highlights cefotaxime as a preferred empiric treatment for SBP.