Everyone Healthy Library
Bacterial Peritonitis
Also Known As: Spontaneous Bacterial Peritonitis
Condition / disease reference page from the Everyone Healthy database.
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Linked signs and symptoms
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Linked drugs / medications
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Treatments, therapies and supportive options
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Medical therapy
1Lifestyle changes
1Linked diagnostic tests and investigations
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Biological markers/agents
8This visual map shows biological markers/agents reported as increased or decreased with this condition. These are educational relationships only; test results must be interpreted by a qualified clinician because ranges vary by lab, method, age, sex and clinical context.
Often increased
7- Alpha-1 Antintrypsin (AAT)Reference range exampleAdult ( > 16y): 90–215 mg/dLLinked diagnostic testsAlpha-1 Antitrypsin (AAT) Concentration
- Alpha-1-Globulin (Blood, Serum)Reference range exampleAll: 0.1–0.3 gm/dLLinked diagnostic testsProtein Electrophoresis (Blood, Serum Protein)
- Alpha-2-Globulin (Blood, Serum)Reference range exampleAll: 0.6–1 gm/dLLinked diagnostic testsProtein Electrophoresis (Blood, Serum Protein)
- Lactic Acid (Venous Blood)Reference range exampleAll: 0.5–2.2 mEq/LLinked diagnostic testsLactic Acid Concentration
- LipaseReference range exampleAdult ( > 16y): 10–140 units/LLinked diagnostic testslipase concentration
- Segmented NeutrophilsReference range exampleAdult ( > 16y): 50–62 %; Adult ( > 16y): 2,500–8,000 mm3Linked diagnostic testsDifferential White Blood Cell Count Tests, Neutrophil Absolute Count
- White Blood Cell (WBC)Reference range exampleAdult ( > 16y): 4.5–10.5 million/mL; Adult ( > 16y): 3.2–10 million/mLLinked diagnostic testsWhite Blood Cell (WBC) Count
Often decreased
1Introduction / full article
Bacterial Peritonitis
Bacterial Peritonitis
Spontaneous bacterial peritonitis (SBP) is bacterial infection of the fluid found within the peritoneal cavity, or ascetic fluid. This occurs acutely and is usually associated with patients undergoing peritoneal dialysis due to contamination of the dialysate fluid. Other populations at risk of developing spontaneous bacterial peritonitis include those with cirrhosis, nephrosis, and congestive heart failure.
Pathophysiology
It has been thought that spontaneous bacterial peritonitis develops through the mechanism called bacterial translocation. Bacterial organisms found within the lumen of the intestine migrates transmurally, resulting to an infection of the ascitic fluid. Another possible mechanism is that the source of the infecting organism comes from the blood, and combined with an impaired immune system, may lead to this condition.
Seventy-five percent of the pathogens causing spontaneous bacterial peritonitis are aerobic gram-negative organisms such as Escherichia coli. The remaining causative organisms include aerobic gram-positive bacteria (eg, streptococci, Enterobateriaceae). Approximately 92% of the cases are able to isolate a single organism, while 8% are caused by a mix of several bacteria (polymicrobial)
Patients who are highly predisposed to developing spontaneous bacterial peritonitis are those who are in a decompensated state with their liver cirrhosis. Patients with low protein levels in the ascitic fluid also have a higher risk.
Epidemiology
Among patients with ascites, the prevalence rate may reach up to 18%. The mortality rate ranges from 40-70% in adults with cirrhosis while it is lower in children with nephrosis.
Clinical Features
As many as 30% of cases of spontaneous bacterial peritonitis have no presenting symptoms. The most common symptoms include fever and chills, abdominal pain or discomfort, worsening encephalopathy, diarrhea, ileus, and worsening ascities or renal failure. In these patients, they usually have abdominal tenderness, have low blood pressure, and have signs of liver failure.
Diagnosis
A very important test is the peritoneal fluid analysis. The ascitic fluid is examined for its cell and differential counts, culture studies, cytology, lactate and pH levels. The ascitic fluid can be obtained through a procedure called paracentesis.
Radiographs of the chest and abdomen may be taken if a perforated bowel is being considered. Ultrasonography can confirm the presence of ascitic fluid and guide paracentesis.
Treatment
Antibiotics are initiated immediately in order to reduce morbidity and prevent complications. The most commonly used regimen is the combination of an aminoglycoside and ampicillin, which provides empiric coverage. Third generation cephalosporins are equally as effective and reduces the risk of nephrotoxicity or problems to the kidneys. Antibiotics are usually given for 10 to 14 days.