[Spontaneous bacterial peritonitis: a severe complication of liver cirrhosis]

Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication of decompensated cirrhosis. SBP is defined as an infection of initially sterile ascitic fluid (AF) without a detectable, surgically treatable source of infection.

To evaluate the prevalence, incidence, pathogens and clinical outcome of patients with liver cirrhosis and SBP.

A prospective study evaluated 34 episodes of SBP developed in 29 patients with cirrhosis and ascites admitted in hospital. SBP was diagnosed based on a polymorphonuclear cell count in ascitic fluid of > 250 cells/mm3 in the absence of data compatible with secondary peritonitis.

The mean age of the group was 56.89 +/- 8.79 years, more frequently occurred in men 21 of 29 cases (72.41%). Microorganisms were isolated in 12 episodes (35.29%): Gram-negative bacteria in 8 (66.67%) and Gram-positive in 4 (33.33%). The first-line treatment failure and in-hospital mortality rates were 26.47% and 17.64%, respectively. The low in-hospital mortality seems to be related to earlier diagnosis and treatment. In the multivariate analysis, three significant independent predictive factors of in-hospital mortality were identified: a high Model of End-Stage Liver Disease (MELD) score, renal failure and SBP caused by extended-spectrum a-lactamase-producing organisms. The relapse rate of PBS was 21.73%.

SBP remains to be a serious complication, especially in patients with a high MELD score. Ceftazidim represents a good choice in empirical treatment of SBP.