[Spontaneous bacterial peritonitis, a severe complication in patients with liver cirrhosis]

Three patients with hepatic cirrhosis and ascites, a 65-year-old man, a 17-year-old woman and a 49-year-old man, were admitted to hospital for progressive drowsiness, increased ascites, and melaena, respectively. An elevated number of polymorphonuclear leukocytes was found in the ascites. The three patients became more and more seriously ill. On the basis of the laboratory findings, a diagnosis of 'spontaneous bacterial peritonitis' was made. The patients recovered after administration of antibiotics. The signs and symptoms of spontaneous bacterial peritonitis can range from subtle, renal dysfunction or an altered mental state to the signs ofan acute abdomen. The common signs of infection such as fever and an elevated leukocyte count are present in only 50% of the patients. Gram-negative bacteria are most frequently isolated from cultures of the ascites fluid. The 1-year mortality is still 50-70% and is partly a result of the underlying liver disease. Prophylactic oral administration of a quinolone decreases the risk of spontaneous bacterial peritonitis in patients with gastrointestinal haemorrhage and in patients with a prior episode of spontaneous bacterial peritonitis. Long-term prophylaxis has been associated with the development of infections with quinolone-resistant microorganisms.