SBP

What is spontaneous bacteria peritonitis (SBP)?

An infection of the peritoneal fluid, the fluid that lines the abdominal cavity.

Why does SBP happen?

- Bacterial translocation:

o Decreased GI motility

o Flora disturbances

o Decreased GI blood flow

o Decreased local and humoral immunity

- Organisms translocate from GI into lymphatic system

- "Leaky" lymphatics leak into peritoneal space leading to ascites

- If bacteria follows -> SBP

What are the most common bugs that cause SBP?

E. coli > Klebsiella pneumoniae > Staph Aureus > E. Faecalis > E. Faecium

What are SBP signs?

- Asymptomatic

- Fever

- Leukocytosis

- Abdominal pain, tenderness

- Altered mental state

- N/V

- Renal failure/acidosis

- Septic shock

What does the ascitic fluid analysis look like in SBP?

o Polymorphonuclear (PMN) count > 250 /cells/mm3

o Cloudy/turbid

o Fluid lactate > 25 mg/dL

o Fluid pH < 7.35

Patients with ascites + signs/symptoms of infection, but with PMN <250?

Should be empirically treated with antibiotics

How should SBP be treated?

2 WAYS

- All patients with ascitic fluid PMN > 250 cells/mm3 in a setting consistent with ascitic fluid infection should receive empiric IV antibiotics

- Patients with PMN < 250 cells/mm3 but have signs of SBP (fever, abdominal pain/tenderness) should also receive empiric therapy

SBP drug therapy?

- Ceftriaxone 2g IV daily or

- Cefotaxime 2g IV q12 hours

x 5 DAYS

Monitoring in SBP?

- Repeat paracentesis/thoracentesis 2 days after initiation

- Decrease in PMN < 25% indicates resistance

Primary prevention drugs in SBP?

- Ciprofloxacin 500 mg PO daily

- TMP/SMX DS PO daily

*Therapy continued indefinitely

Secondary Prevention of SBP

- For those who have SURVIVED an episode of SBP

- Indefinite antibiotic prevention

- Same regimens as primary prophylaxis

What is the role of IV albumin in patients with SBP?

- Main blood protein, synthesized in liver; better marker of true hepatic function

- Important in maintaining plasma oncotic pressure

- In cirrhosis, albumin production is reduced. Reduced oncotic pressure leads to "leaky" vessels contributing to ascites formation

How and when should IV albumin therapy be used in SBP?

- Adjunctive Treatment for SBP:

o All patients

o Patients with AKI and/or jaundice more likely to benefit

o Improves renal perfusion and mortality but maintain intravascular volume

Dosing of Albumin

o Dosing: 1.5 g/kg IV on day 1, then 1 g/kg on day 3

**Always in conjunction with antibiotics