Koulaouzidis A, Bhat S, Saeed AA. Spontaneous bacterial peritonitis. World J Gastroenterol 2009; 15(9): 1042-1049 [PMID: 19266595 DOI: 10.3748/wjg.15.1042]
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Anastasios Koulaouzidis, MD, MRCP, Endoscopy Unit, Centre of Liver & Digestive Disorders, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Scotland, EH16 4SA, United Kingdom. akoulaouzidis@hotmail.com
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World J Gastroenterol. Mar 7, 2009; 15(9): 1042-1049 Published online Mar 7, 2009. doi: 10.3748/wjg.15.1042
Spontaneous bacterial peritonitis
Anastasios Koulaouzidis, Shivaram Bhat, Athar A Saeed
Anastasios Koulaouzidis, Endoscopy Unit, Centre of Liver & Digestive Disorders, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Scotland, EH16 4SA, United Kingdom
Athar A Saeed, Gastroenterology Department, Queen Elizabeth Hospital, Gateshead, Tyne & Wear, NE9 6SX, United Kingdom
Author contributions: Koulaouzidis A, Bhat S and Saeed AA contributed equally to this work; Koulaouzidis A designed the review, wrote the introduction, pathogenesis, laboratory diagnosis, and variants, and had overall supervision; Bhat S wrote management; Saeed AA wrote clinical manifestations.
Correspondence to: Anastasios Koulaouzidis, MD, MRCP, Endoscopy Unit, Centre of Liver & Digestive Disorders, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Scotland, EH16 4SA, United Kingdom. akoulaouzidis@hotmail.com
Telephone: +44-131-2421603
Fax: +44-131-2421618
Received: December 24, 2008 Revised: January 8, 2009 Accepted: January 15, 2009 Published online: March 7, 2009
Abstract
Since its initial description in 1964, research has transformed spontaneous bacterial peritonitis (SBP) from a feared disease (with reported mortality of 90%) to a treatable complication of decompensated cirrhosis, albeit with steady prevalence and a high recurrence rate. Bacterial translocation, the key mechanism in the pathogenesis of SBP, is only possible because of the concurrent failure of defensive mechanisms in cirrhosis. Variants of SBP should be treated. Leucocyte esterase reagent strips have managed to shorten the ‘tap-to-shot’ time, while future studies should look into their combined use with ascitic fluid pH. Third generation cephalosporins are the antibiotic of choice because they have a number of advantages. Renal dysfunction has been shown to be an independent predictor of mortality in patients with SBP. Albumin is felt to reduce the risk of renal impairment by improving effective intravascular volume, and by helping to bind pro-inflammatory molecules. Following a single episode of SBP, patients should have long-term antibiotic prophylaxis and be considered for liver transplantation.
