How is spontaneous bacterial peritonitis diagnosed and treated?

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Multiple Choice

How is spontaneous bacterial peritonitis diagnosed and treated?

Spontaneous bacterial peritonitis is diagnosed by analyzing the ascitic fluid obtained from diagnostic paracentesis. The key finding is a neutrophil count in the ascitic fluid of 250 cells per microliter or higher, which confirms infection even if the patient’s fever or abdominal findings are subtle. Cultures can help, but many cases are culture-negative, so the cell count is the decisive criterion. Treatment begins with prompt empiric antibiotics that cover the common organisms causing SBP, typically a third-generation cephalosporin such as cefotaxime or ceftriaxone. Because patients with cirrhosis and SBP are at risk for circulatory dysfunction and renal failure, accompanying therapy with intravenous albumin is recommended to reduce the risk of renal complications and improve survival. The usual approach is to give albumin on day one and day three of therapy, with the exact dosing tailored to the patient’s kidney function and overall status. In short, diagnose SBP by ascitic fluid analysis showing a high PMN count, and treat immediately with a third-generation cephalosporin plus IV albumin to protect renal function and reduce mortality. Fever alone is not diagnostic, a very low PMN count would not indicate SBP, and ultrasound or steroids do not establish the diagnosis or appropriate treatment.

Spontaneous bacterial peritonitis is diagnosed by analyzing the ascitic fluid obtained from diagnostic paracentesis. The key finding is a neutrophil count in the ascitic fluid of 250 cells per microliter or higher, which confirms infection even if the patient’s fever or abdominal findings are subtle. Cultures can help, but many cases are culture-negative, so the cell count is the decisive criterion.

Treatment begins with prompt empiric antibiotics that cover the common organisms causing SBP, typically a third-generation cephalosporin such as cefotaxime or ceftriaxone. Because patients with cirrhosis and SBP are at risk for circulatory dysfunction and renal failure, accompanying therapy with intravenous albumin is recommended to reduce the risk of renal complications and improve survival. The usual approach is to give albumin on day one and day three of therapy, with the exact dosing tailored to the patient’s kidney function and overall status.

In short, diagnose SBP by ascitic fluid analysis showing a high PMN count, and treat immediately with a third-generation cephalosporin plus IV albumin to protect renal function and reduce mortality. Fever alone is not diagnostic, a very low PMN count would not indicate SBP, and ultrasound or steroids do not establish the diagnosis or appropriate treatment.

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