Spontaneous Bacterial Peritonitis
OVERVIEW
- incidence 20% in those with ascites admitted to hospital
- often occurs in patients with severe hepatic dysfunction -> should lead to transplantation consideration if appropriate
CLINICAL FEATURES
- fever
- abdominal pain
- abdominal tenderness
- worsening encephalopathy
- renal failure
INVESTIGATIONS
Ascitic Tap
- – > 250-500/mm3 WCC
- – > 250/mm3 neutrophils
- bacteria are rarely detected on gram stain
- place some fluid into blood culture bottles
Organisms
- Gram negative bacilli (E coli)
- Streptococcus pneumoniae
- Other Streptococci
- Enterococci
MANAGEMENT
Treatment
- ceftriaxone 25mg/kg up to 1g OD or
- cefotaxime 25mg/kg up to 1g Q8hrly or
- ticarcillin+clavulanate 50+1.7mg/kg up to 3+0.1g Q6 hrly
- if patient on co-trimoxazole or norfloxacin prophylaxis added in amoxy/ampicillin 25mg/kg up to 1g Q6 hrly
- 5-10 days
- IV albumin (decreases risk of hepatorenal syndrome) 2-5mL/kg 20% albumin up to 100mL BD for 3/7
Prophylaxis
- ascites + upper GI bleeding + hospital
- low ascitic protein concentration
- previous SBP
- cotrimoxazole 4+20mg/kg up to 160+800mg PO OD
- immunize against pneumococcus
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC