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Spontaneous Bacterial Peritonitis (SBP)

Infection of ascitic fluid without an obvious source of infection.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dahiliye (İç Hastalıkları) department. Book Appointment →

What is Spontaneous Bacterial Peritonitis (SBP)?

Spontaneous bacterial peritonitis (SBP) is the development of infection in ascitic fluid in patients with cirrhotic ascites without a source such as intra-abdominal surgery or perforation. Bacterial translocation — the passage of bacteria from the intestinal lumen to the portal circulation and from there to the ascitic fluid — is the main pathogenetic mechanism.

The most common pathogens are gram-negative enteric bacteria, primarily Escherichia coli. In recent years, gram-positive and resistant microorganisms have also been seen with increasing frequency in patients on quinolone prophylaxis.

Diagnosis is made by finding a polymorphonuclear (PMN) cell count ≥250/mm³ in ascitic fluid obtained by paracentesis. Mortality is very high if left untreated; early antibiotic and albumin therapy significantly improves prognosis.

Symptoms

Fever and chills
Diffuse abdominal pain and tenderness
Rapid increase in ascites
Nausea, vomiting, and diarrhea
Confusion and exacerbation of hepatic encephalopathy
Deterioration of renal function
Hypotension and tachycardia

Risk Factors

Advanced cirrhosis (Child-Pugh B or C)
Previous history of SBP
Low ascitic fluid protein level (<1.5 g/dL)
Gastrointestinal bleeding
Use of proton pump inhibitors
High serum bilirubin level
Hypoalbuminemia and malnutrition

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • If a cirrhotic patient develops fever and abdominal pain
  • If the amount of ascites increases rapidly
  • If signs of encephalopathy appear
  • If renal function begins to deteriorate
  • If blood pressure drops and urine output decreases (urgent)

Treatment Methods

01
Urgent diagnostic paracentesis for diagnosis (before antibiotics)
02
Empirical 3rd generation cephalosporin (cefotaxime or ceftriaxone) for 5-7 days
03
IV albumin (1-1.5 g/kg) — reduces renal failure and mortality
04
Discontinuation of nephrotoxic drugs and NSAIDs
05
Prophylaxis: norfloxacin or ciprofloxacin (in patients at high risk of recurrence)
06
Liver transplantation evaluation

Which Department to Visit?

You can visit our Dahiliye (İç Hastalıkları) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.