Spontaneous Bacterial Peritonitis: We Are Still Behind

Abstract

Spontaneous bacterial peritonitis (SBP) is an infection in the ascitic fluid. Despite published guidelines, an inappropriate diagnosis of SBP is frequent. In this study, we aim to evaluate guideline adherence in diagnosing SBP. This is a retrospective study conducted between January 2015 and January 2018. Based on the American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of Liver (EASL), two authors judged guideline adherence in SBP diagnosis and management. One hundred and six patients were included in the study, and 93% were hospitalized. The mean age was 56.9 years, and 62 patients were males. In addition, Caucasians were the most common ethnicity (86.8%). The authors judged that only 52.4% of patients were appropriately diagnosed, and only 67.3% were managed with proper treatment. Inpatient mortality was documented in five patients, and the readmission rate within 30-days after discharge was 29.3%. In conclusion, SBP is a common complication of cirrhosis, which can be managed with adherence to published guidelines. In our population, guidelines were not implemented in diagnosing nearly half the SBP patients, mostly due to misdiagnosis of SBP with secondary peritonitis or non-neutrocytic bacteriascites, starting antibiotics before performing the paracentesis, and even giving broad-coverage antibiotics when not indicated. Further efforts are needed to enhance adherence to guidelines in clinical practice.

Diagnosis of spontaneous bacterial peritonitis in patients with chronic liver disease: Role of leukocyte esterase dipstick test.

“…SBP is described as formation of infection in the abdominal cavity and a clear of source of infection is not known usually. 1,2 SBP occurs frequently among patients of portal hypertension which is commonly due to liver cirrhosis. 3 Patients having nephrotic syndrome are also prone to increased risk of SBP.…”

Predictors of spontaneous bacterial peritonitis in Romanian adults with liver cirrhosis: Focus on the neutrophil‑to‑lymphocyte ratio

“…There is a variant in which the PMN value is <250 mm 3 , but with present culture called monomicrobial bacterascitis (4). Despite the diagnostic and treatment recommendations in the guideline, in a retrospective study made in the USA, only 52.4% of patients diagnosed with SBP met the criteria and only 67.3% of patients received appropriate treatment (5). The diagnostic challenge lies in the fact that the symptomatology of patients with SBP varies from typical symptoms to their partial or complete absence.…”

Diagnostic Model for Spontaneous Bacterial Peritonitis in Cirrhotic Patients with Ascites

“…In recent years, the prognosis of SBP has improved considerably due to effective antibiotic treatment; however, the mortality rate remains as high as 30% [11]. Patients with cirrhosis have immune dysfunction [12]. Delayed diagnosis of SBP leads to rapid disease progression and further deterioration of immune function, which leads to decreased effectiveness of antibiotic therapy.…”

“…According to the European guidelines, SBP is diagnosed based on a polymorphonuclear (PMN) leukocyte count ≥ 250 /mm 3 in ascetic uid and exclusion of secondary causes of intraabdominal infection. A retrospective study from the United States found that only 52.4% of SBP patients ful lled the PMN diagnostic criteria [12]. In addition, abdominocentesis is required to determine the ascitic uid PMN count.…”

“…Because highly sensitive and speci c biomarkers for the diagnosis of SBP in cirrhotic ascites are not available, the diagnosis is often delayed. Several studies have reported unsatisfactory diagnostic accuracy of PMN for SBP [12]. Ascitic bacterial culture is vital for the diagnosis of SBP, but the positive rate is low and the test is time-consuming.…”