Spontaneous bacterial peritonitis

Vignette says a 55 year old male with a history of cirrhosis and ascites due to chronic alcohol use presents to the emergency department with chief complaints of diffuse abdominal pain, vomiting, and a mild low grade fever over the past two days; He also reports of fatigue and increasing confusion; Vital signs show blood pressure of 100/60 mm of Hg, pulse rate of 108 bpm, respiratory rate of 18 breaths/min, oxygen saturation of 92% in RA and temperature of 100.2 F; Abdominal examination shows distended abdomen with shifting dullness, mild diffuse tenderness, and hypoactive bowel sounds on auscultation; CBC shows WBC count of 14,000 cells/mm3, serum creatinine of 1.8 mg/dL (normal range is 0.7mg/dL-1.3mg/dL), serum albumin of 2.1g/dL (normal range is 3.5-5.5 g/dL); Paracentesis with ascitic fluid absolute neutrophil count is 380 cells/mm3; Diagnosis?

Diagnosis is Spontaneous bacterial peritonitis (SBP).

Spontaneous bacterial peritonitis (SBP) is defined as the infection of the ascitic fluid.

Presents with fever, diffuse abdominal pain in patients with liver cirrhosis along with ascitic fluid absolute neutrophil count (ANC) > 250 cells/mm3.

Etiologic agents are Escherichia coli (most common), Klebsiella, Streptococcus pneumoniae.

Diagnosis:-

1. Paracentesis with ascitic fluid absolute neutrophil count (ANC) > 250 cells/mm3.

2. Gram staining and culture of the ascitic fluid.

Management:-

1. 3rd generation cephalosporins (e.g. cefotaxime, ceftriaxone).

2. Albumin infusion to prevent kidney failure.

3. Prophylactic ciprofloxacin or trimethoprim/sulfamethoxazole is used to prevent SBP if ascitic fluid albumin is low.