Complicated Persistent Peritonitis

Spontaneous bacterial peritonitis (SBP) is a common complication of end-stage liver disease. SBP can present with many symptoms such as abdominal pain, fever and altered mental status. The diagnosis of SBP is made when ascitic fluid from a paracentesis has an absolute neutrophil count (ANC) more than 250/uL, there is a positive ascitic fluid culture, and no secondary source of infection can be idenitifed. However, nearly 60% of patients with SBP have negative fluid cultures. These patients can still potentially have SBP and should be treated as such since in-hospital mortality ranges from 20-40%. Conventional treatment for SBP includes a third-generation cephalosporin for five days, followed by lifetime prophylaxis most commonly with a fluoroquinolone. After 48 hours of antibiotic treatment, a repeat paracentesis should be performed. If the ANC does not decrease by at least 25%, it is considered a therapeutic failure and the antibiotic should be changed. With early diagnosis and appropriate antibiotic regimen, SBP is treatable.