Liver & GIT
Most common organism causing spontaneous bacterial peritonitis
Spontaneous or Primary Bacterial Peritonitis (SBP) (Ref. H-18th Edi, Pg 2601)
1. Peritonitis without an apparent source of infection is k/a SBP.
2. SBP occurs most commonly in conjunction with cirrhosis of the liver.
3. SBP virtually develops in all patients of ascites.
4. In a patient in whom a diseased liver and altered portal circulation results in a defect in the usual filtration function.
5. Fever & Rebound Tenderness are the features.
Microbiology of SBP
1. Most common organism is E. coli (enteric gram negative bacilli).
2. Gram positive organisms such as streptococci, enterococci or even pneumococci can be implicated.
Diagnostic criteria of spontaneous bacterial peritonitis
The finding of> 250 PMNs per ml is diagnostic for spontaneous bacterial peritonitis. (H 18thPg- 2601)
Treatment of SBP
1. Third generation cephalosporinscefotaxime
2. Broad spectrum antibiotics such as penicillin/B lactamase inhibitor or ceftriaxone
3. Large volume paracentesis should not be done.
i. SBP has a high rate of recurrence. Up to 70% of patients experience a recurrence within 1 year.
ii. Antibiotic prophylaxis reduces the rate of recurrence to < 20%.
iii. Drugs used for prophylaxis are
c. Trimethoprim sulfamethoxazole.