Spontaneous bacterial peritonitis: Difference between revisions

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In [[medicine]], [[spontaneous bacterial peritonitis]] is a form of peritonitis that occurs in patient with [[ascites]].<ref>[[ICD9]]: {{ICD9|567.23}}</ref>
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In [[medicine]], [[spontaneous bacterial peritonitis]] (SB) is a form of peritonitis that occurs in patient with [[ascites]].<ref>[[ICD9]]: {{ICD9|567.23}}</ref> Monomicrobial nonneutrocytic bacterascites is a positive culture for a pure growth of a single type of organism but the neutrophil count is less than 250 cells/mm<sup>3</sup>.<ref name="pmid2210672">{{cite journal| author=Runyon BA| title=Monomicrobial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis. | journal=Hepatology | year= 1990 | volume= 12 | issue= 4 Pt 1 | pages= 710-5 | pmid=2210672
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2210672 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> About a third of patients with monomicrobial nonneutrocytic bacterascites will progress to SBP.<ref name="pmid2210672"/>


==Etiology/cause==
==Etiology/cause==
Line 6: Line 8:


==Diagnosis==
==Diagnosis==
On [[physical examination]], most patients have mild abdominal pain.<ref name="pmid18433932">{{cite journal |author=Chinnock B, Afarian H, Minnigan H, Butler J, Hendey GW |title=Physician clinical impression does not rule out spontaneous bacterial peritonitis in patients undergoing emergency department paracentesis |journal=Ann Emerg Med |volume=52 |issue=3 |pages=268–73 |year=2008 |month=September |pmid=18433932 |doi=10.1016/j.annemergmed.2008.02.016 |url=http://linkinghub.elsevier.com/retrieve/pii/S0196-0644(08)00552-0 |issn=}}</ref>
===Physical examination===
 
On [[physical examination]], most patients have mild abdominal pain.<ref name="pmid18433932">{{cite journal |author=Chinnock B, Afarian H, Minnigan H, Butler J, Hendey GW |title=Physician clinical impression does not rule out spontaneous bacterial peritonitis in patients undergoing emergency department paracentesis |journal=Ann Emerg Med |volume=52 |issue=3 |pages=268–73 |year=2008 |month=September |pmid=18433932 |doi=10.1016/j.annemergmed.2008.02.016 |url=http://linkinghub.elsevier.com/retrieve/pii/S0196-0644(08)00552-0 |issn=}}</ref> The impression of the physician performing the [[physical examination]] may not be accurate:<ref name="pmid18433932">{{cite journal |author=Chinnock B, Afarian H, Minnigan H, Butler J, Hendey GW |title=Physician clinical impression does not rule out spontaneous bacterial peritonitis in patients undergoing emergency department paracentesis |journal=Ann Emerg Med |volume=52 |issue=3 |pages=268–73 |year=2008 |month=September |pmid=18433932 |doi=10.1016/j.annemergmed.2008.02.016 |url=http://linkinghub.elsevier.com/retrieve/pii/S0196-0644(08)00552-0 |issn=}}</ref>
The impression of the physician performing the [[physical examination]] may not be accurate:<ref name="pmid18433932">{{cite journal |author=Chinnock B, Afarian H, Minnigan H, Butler J, Hendey GW |title=Physician clinical impression does not rule out spontaneous bacterial peritonitis in patients undergoing emergency department paracentesis |journal=Ann Emerg Med |volume=52 |issue=3 |pages=268–73 |year=2008 |month=September |pmid=18433932 |doi=10.1016/j.annemergmed.2008.02.016 |url=http://linkinghub.elsevier.com/retrieve/pii/S0196-0644(08)00552-0 |issn=}}</ref>
* [[sensitivity (tests)|sensitivity]] = 76%
* [[sensitivity (tests)|sensitivity]] = 76%
* [[specificity (tests)|specificity]] = 34%
* [[specificity (tests)|specificity]] = 34%
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** [[sensitivity (tests)|sensitivity]] = 94%
** [[sensitivity (tests)|sensitivity]] = 94%
** [[specificity (tests)|specificity]] = 15%
** [[specificity (tests)|specificity]] = 15%
===Ascitic fluid analysis===
Performance and interpretation of the paracentesis has been [[systematic review|systematically reviewed]] by the [http://jama.ama-assn.org/cgi/collection/rational_clinical_exam Rational Clinical Examination].<ref name="pmid18334692">{{cite journal| author=Wong CL, Holroyd-Leduc J, Thorpe KE, Straus SE| title=Does this patient have bacterial peritonitis or portal hypertension? How do I perform a paracentesis and analyze the results? | journal=JAMA | year= 2008 | volume= 299 | issue= 10 | pages= 1166-78 | pmid=18334692
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18334692 | doi=10.1001/jama.299.10.1166 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>


==Treatment==
==Treatment==
The role of antibiotics is not clear as "oral [[quinolone]]s could be considered an option for those with less severe manifestations".<ref name="pmid19160207">{{cite journal |author=Chavez-Tapia NC, Soares-Weiser K, Brezis M, Leibovici L |title=Antibiotics for spontaneous bacterial peritonitis in cirrhotic patients |journal=Cochrane Database Syst Rev |volume= |issue=1 |pages=CD002232 |year=2009 |pmid=19160207 |doi=10.1002/14651858.CD002232.pub2 |url=http://dx.doi.org/10.1002/14651858.CD002232.pub2 |issn=}}</ref>
The role of antibiotics is not clear.<ref name="pmid19160207">{{cite journal |author=Chavez-Tapia NC, Soares-Weiser K, Brezis M, Leibovici L |title=Antibiotics for spontaneous bacterial peritonitis in cirrhotic patients |journal=Cochrane Database Syst Rev |volume= |issue=1 |pages=CD002232 |year=2009 |pmid=19160207 |doi=10.1002/14651858.CD002232.pub2 |url=http://dx.doi.org/10.1002/14651858.CD002232.pub2 |issn=}}</ref>


===Oral treatment===
===Oral treatment===
"Oral [[quinolone]]s could be considered an option for those with less severe manifestations" according to the [[Cochrane Collaboration]].<ref name="pmid19160207">{{cite journal |author=Chavez-Tapia NC, Soares-Weiser K, Brezis M, Leibovici L |title=Antibiotics for spontaneous bacterial peritonitis in cirrhotic patients |journal=Cochrane Database Syst Rev |volume= |issue=1 |pages=CD002232 |year=2009 |pmid=19160207 |doi=10.1002/14651858.CD002232.pub2 |url=http://dx.doi.org/10.1002/14651858.CD002232.pub2 |issn=}}</ref>
{| class="wikitable"
{| class="wikitable"
|+ [[Randomized controlled trial]]s of oral antibiotics for non-severe spontaneous bacterial peritonitis<ref name="grange2004">Grange J. Randomized, comparative study of moxifloxacin versus amoxicillin-clavulanate in the treatment of bacterial infections in cirrhotic patients. Hepatology 2004;40(4 (Suppl 1)):631A.</ref><ref name="pmid14571754">{{cite journal| author=Tuncer I, Topcu N, Durmus A, Turkdogan MK| title=Oral ciprofloxacin versus intravenous cefotaxime and ceftriaxone in the treatment of spontaneous bacterial peritonitis. | journal=Hepatogastroenterology | year= 2003 Sep-Oct | volume= 50 | issue= 53 | pages= 1426-30 | pmid=14571754  
|+ [[Randomized controlled trial]]s of oral antibiotics for spontaneous bacterial peritonitis<ref name="pmid14571754">{{cite journal| author=Tuncer I, Topcu N, Durmus A, Turkdogan MK| title=Oral ciprofloxacin versus intravenous cefotaxime and ceftriaxone in the treatment of spontaneous bacterial peritonitis. | journal=Hepatogastroenterology | year= 2003 Sep-Oct | volume= 50 | issue= 53 | pages= 1426-30 | pmid=14571754  
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14571754 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref><ref name="pmid10782908">{{cite journal| author=Ricart E, Soriano G, Novella MT, Ortiz J, Sàbat M, Kolle L et al.| title=Amoxicillin-clavulanic acid versus cefotaxime in the therapy of bacterial infections in cirrhotic patients. | journal=J Hepatol | year= 2000 | volume= 32 | issue= 4 | pages= 596-602 | pmid=10782908 |doi=10.1016/S0168-8278(00)80221-4
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14571754 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref><ref name="pmid10782908">{{cite journal| author=Ricart E, Soriano G, Novella MT, Ortiz J, Sàbat M, Kolle L et al.| title=Amoxicillin-clavulanic acid versus cefotaxime in the therapy of bacterial infections in cirrhotic patients. | journal=J Hepatol | year= 2000 | volume= 32 | issue= 4 | pages= 596-602 | pmid=10782908 |doi=10.1016/S0168-8278(00)80221-4
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10782908 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref><ref name="pmid11059861">{{cite journal| author=Terg R, Cobas S, Fassio E, Landeira G, Ríos B, Vasen W et al.| title=Oral ciprofloxacin after a short course of intravenous ciprofloxacin in the treatment of spontaneous bacterial peritonitis: results of a multicenter, randomized study. | journal=J Hepatol | year= 2000 | volume= 33 | issue= 4 | pages= 564-9 | pmid=11059861  
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10782908 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref><ref name="pmid11059861">{{cite journal| author=Terg R, Cobas S, Fassio E, Landeira G, Ríos B, Vasen W et al.| title=Oral ciprofloxacin after a short course of intravenous ciprofloxacin in the treatment of spontaneous bacterial peritonitis: results of a multicenter, randomized study. | journal=J Hepatol | year= 2000 | volume= 33 | issue= 4 | pages= 564-9 | pmid=11059861  
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|-
|-
! Intervention!!Control
! Intervention!!Control
<!--
This is not a study of PO versus IV but is a study of IV->PO moxifloxacin versus IV->PO amoxicillin-clavulanic acid
|-
|-
| Grange<ref name="grange2004"/><br/>2004|| 35 patients||  moxifloxacin versus amoxicillin-clavulanic acid|| cell|| cell|| cell
| Grange<ref name="grange2004">Grange J. Randomized, comparative study of moxifloxacin versus amoxicillin-clavulanate in the treatment of bacterial infections in cirrhotic patients. Hepatology 2004;40(4 (Suppl 1)):631A.</ref><br/>2004|| 35 patients||  moxifloxacin versus amoxicillin-clavulanic acid|| SBP resolution|| 94%|| 100%
-->
|-
|-
| Tuncer<ref name="pmid14571754"/><br/>2003 ||53 patients|| oral ciprofloxacin versus IV cefotaxime with IV ceftriaxone|| cell|| cell|| cell
| Tuncer<ref name="pmid14571754"/><br/>2003 ||53 patients|| Oral ciprofloxacin versus one of two IV third-generation cephalosporins||SBP resolution|| 84%|| 76% and 83%
|-
|-
| Ricart<ref name="pmid10782908"/><br/>2000|| 48 patients||  oral amoxicillin-clavulanic acid for an average of 2.6 days then orallly for an average of 5.6 days versus cefotaxime IV for an average of 8 days|| cell|| cell|| cell
| Ricart<ref name="pmid10782908"/><br/>2000|| 48 patients||  Oral amoxicillin-clavulanic acid for an average of 2.6 days then orallly for an average of 5.6 days versus cefotaxime IV for an average of 8 days|| Hospital survival|| 90%|| 83%
|-
|-
| Terg<ref name="pmid11059861"/><br/>1997|| 80 patients|| ciprofloxacin IV for two days then oral for 5 days versus ciprofloxacin IV for seven days|| cell|| cell|| cell
| Terg<ref name="pmid11059861"/><br/>1997|| 80 patients. No exclusion criteria|| Oral ciprofloxacin for five days after IV for two days versus ciprofloxacin IV for seven days|| Hospital survival|| 77.5%|| 77.5%
|-
|-
| Figueiredo<ref name="Figueiredo1997"/><br/>1996|| 38 patients||oral cefixime versus IV ceftriaxone|| cell|| cell|| cell
| Figueiredo<ref name="Figueiredo1997"/><br/>1996|| 38 patients||Oral cefixime versus IV ceftriaxone|| Survival after two days of stopping antibiotics|| 80%|| 83%
|-
|-
| Navasa<ref name="navasa1996"/><br/>1996 || 123 patients|| oral ofloxacin versus IV cefotaxime|| cell|| cell|| cell
| Navasa<ref name="navasa1996"/><br/>1996 || 123 patients. Excluded septic shock, grade II-IV hepatic encephalopathy, serum creatinine level of > 3 mg/dL, and gastrointestinal hemorrhage or ileus|| Oral ofloxacin versus IV cefotaxime||Hospital survival|| 100%|| 100%
|}
|}
<references/>


==References==
==References==
<references/>
<references/>

Revision as of 16:58, 26 December 2010

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In medicine, spontaneous bacterial peritonitis (SB) is a form of peritonitis that occurs in patient with ascites.[1] Monomicrobial nonneutrocytic bacterascites is a positive culture for a pure growth of a single type of organism but the neutrophil count is less than 250 cells/mm3.[2] About a third of patients with monomicrobial nonneutrocytic bacterascites will progress to SBP.[2]

Etiology/cause

Proton pump inhibitors may be associated with SBP.[3]

Diagnosis

Physical examination

On physical examination, most patients have mild abdominal pain.[4] The impression of the physician performing the physical examination may not be accurate:[4]

Regarding individual signs and symptoms:

Ascitic fluid analysis

Performance and interpretation of the paracentesis has been systematically reviewed by the Rational Clinical Examination.[5]

Treatment

The role of antibiotics is not clear.[6]

Oral treatment

"Oral quinolones could be considered an option for those with less severe manifestations" according to the Cochrane Collaboration.[6]

Randomized controlled trials of oral antibiotics for spontaneous bacterial peritonitis[7][8][9][10][11]
Trial Patients Comparison Outcome Results
Intervention Control
Tuncer[7]
2003		 53 patients Oral ciprofloxacin versus one of two IV third-generation cephalosporins SBP resolution 84% 76% and 83%
Ricart[8]
2000		 48 patients Oral amoxicillin-clavulanic acid for an average of 2.6 days then orallly for an average of 5.6 days versus cefotaxime IV for an average of 8 days Hospital survival 90% 83%
Terg[9]
1997		 80 patients. No exclusion criteria Oral ciprofloxacin for five days after IV for two days versus ciprofloxacin IV for seven days Hospital survival 77.5% 77.5%
Figueiredo[10]
1996		 38 patients Oral cefixime versus IV ceftriaxone Survival after two days of stopping antibiotics 80% 83%
Navasa[11]
1996		 123 patients. Excluded septic shock, grade II-IV hepatic encephalopathy, serum creatinine level of > 3 mg/dL, and gastrointestinal hemorrhage or ileus Oral ofloxacin versus IV cefotaxime Hospital survival 100% 100%

References

  1. ↑ ICD9: 567.23
  2. ↑ 2.0 2.1 Runyon BA (1990). "Monomicrobial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis.". Hepatology 12 (4 Pt 1): 710-5. PMID 2210672.
  3. ↑ Bajaj JS, Zadvornova Y, Heuman DM, et al. (May 2009). "Association of proton pump inhibitor therapy with spontaneous bacterial peritonitis in cirrhotic patients with ascites". Am. J. Gastroenterol. 104 (5): 1130–4. DOI:10.1038/ajg.2009.80. PMID 19337238. Research Blogging.
  4. ↑ 4.0 4.1 Chinnock B, Afarian H, Minnigan H, Butler J, Hendey GW (September 2008). "Physician clinical impression does not rule out spontaneous bacterial peritonitis in patients undergoing emergency department paracentesis". Ann Emerg Med 52 (3): 268–73. DOI:10.1016/j.annemergmed.2008.02.016. PMID 18433932. Research Blogging.
  5. ↑ Wong CL, Holroyd-Leduc J, Thorpe KE, Straus SE (2008). "Does this patient have bacterial peritonitis or portal hypertension? How do I perform a paracentesis and analyze the results?". JAMA 299 (10): 1166-78. DOI:10.1001/jama.299.10.1166. PMID 18334692. Research Blogging.
  6. ↑ 6.0 6.1 Chavez-Tapia NC, Soares-Weiser K, Brezis M, Leibovici L (2009). "Antibiotics for spontaneous bacterial peritonitis in cirrhotic patients". Cochrane Database Syst Rev (1): CD002232. DOI:10.1002/14651858.CD002232.pub2. PMID 19160207. Research Blogging.
  7. ↑ 7.0 7.1 Tuncer I, Topcu N, Durmus A, Turkdogan MK (2003 Sep-Oct). "Oral ciprofloxacin versus intravenous cefotaxime and ceftriaxone in the treatment of spontaneous bacterial peritonitis.". Hepatogastroenterology 50 (53): 1426-30. PMID 14571754.
  8. ↑ 8.0 8.1 Ricart E, Soriano G, Novella MT, Ortiz J, Sàbat M, Kolle L et al. (2000). "Amoxicillin-clavulanic acid versus cefotaxime in the therapy of bacterial infections in cirrhotic patients.". J Hepatol 32 (4): 596-602. DOI:10.1016/S0168-8278(00)80221-4. PMID 10782908. Research Blogging.
  9. ↑ 9.0 9.1 Terg R, Cobas S, Fassio E, Landeira G, Ríos B, Vasen W et al. (2000). "Oral ciprofloxacin after a short course of intravenous ciprofloxacin in the treatment of spontaneous bacterial peritonitis: results of a multicenter, randomized study.". J Hepatol 33 (4): 564-9. PMID 11059861.
  10. ↑ 10.0 10.1 Figueiredo FAF, Coelho HSM, Soares JAS, Salgueiro E, Pinto CA. Oral cephalosporin for the treatment of non-severe spontaneous bacterial peritonitis in liver disease: a prospective study of 38 cases [Cefalosporina oral para o tratamento da peritonite bacteriana espontanea nao complicada na cirrose hepatica: um estudo prospectivo de 38 casos]. GED - Gastrenterologia-Endoscopia-Digestiva 1997;16(6):231-6.
  11. ↑ 11.0 11.1 Navasa M, Follo A, Llovet JM, Clemente G, Vargas V, Rimola A, et al.Randomized, comparative study of oral ofloxacin versus intravenous cefotaxime in spontaneous bacterial peritonitis. Gastroenterology 1996;111(4):1011-7. DOI:10.1016/S0016-5085(96)70069-0
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