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

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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