Spontaneous bacterial peritonitis: clinical and laboratory features with reference to hospital-acquired cases

A review of a large secondary and tertiary care hospital's experience with spontaneous bacterial peritonitis (SBP) over 7 yr revealed that in most cases this complication emerges after the patient is admitted to the hospital. Compared with a hospitalized control group, SBP patients were more likely to have gastrointestinal bleeding and renal failure and to require invasive procedures or therapies. Thus, hospitalized cirrhotics with ascites who develop SBP are more debilitated before development of SBP. The clinical signs and symptoms of this disorder are diverse; simple tests of ascitic fluid properties (white blood cell count, polymorphonuclear cell count, and lactate dehydrogenase) correlate closely with positive cultures, affording the clinician a chance to make an early presumptive diagnosis. Recognition of nosocomial SBP has important implications for the management of hospitalized cirrhotic patients. Further study is needed to determine if invasive procedures actually cause some cases of SBP or if the apparent association is simply due to identification of a sicker, more debilitated group of patients.