请输入您要查询的百科知识：

　

词条 Spontaneous bacterial peritonitis
释义

  1. Signs and symptoms

  2. Causes

  3. Pathophysiology

  4. Diagnosis

  5. Prevention

  6. Treatment

     Antibiotics  Prokinetics  Intravenous albumin 

  7. Epidemiology

  8. History

  9. References

  10. External links

{{Infobox medical condition (new)
| name = Spontaneous bacterial peritonitis
|
| synonyms =
| symptoms =
| complications =
| onset =
| duration =
| types =
| causes =
| risks =
| diagnosis =
| differential =
| prevention =
| treatment =
| medication =
| prognosis =
| frequency =
| deaths =
}}Spontaneous bacterial peritonitis (SBP) is the development of a bacterial infection in the peritoneum, despite the absence of an obvious source for the infection.[1] It is specifically an infection of the ascitic fluid – an increased volume of peritoneal fluid.[2] Ascites is most commonly a complication of cirrhosis of the liver.[1] It can also occur in patients with nephrotic syndrome.[3][4] SBP has a high mortality rate.[5]

The diagnosis of SBP requires paracentesis, a sampling of the peritoneal fluid taken from the peritoneal cavity.[6] If the fluid contains large numbers of white blood cells known as neutrophils (>250 cells/µL), infection is confirmed and antibiotics will be given, without waiting for culture results.[7] In addition to antibiotics, infusions of albumin are usually administered.[7]

Other life-threatening complications such as kidney malfunction and increased liver insufficiency can be triggered by spontaneous bacterial peritonitis.[8][9] 30%of SBP patients develop kidney malfunction and is one of the strongest predictors for mortality. Where there are signs of this development albumin infusion will also be given.[12]

Spontaneous fungal peritonitis (SFP) can also occur and this can sometimes accompany a bacterial infection.[10]

Signs and symptoms

Signs and symptoms of spontaneous bacterial peritonitis (SBP) include fevers, chills, nausea, vomiting, abdominal pain and tenderness, general malaise, altered mental status, and worsening ascites.[1] Thirteen percent of patients have no signs or symptoms.[15] In cases of acute or chronic liver failure SBP is one of the main triggers for hepatic encephalopathy, and where there is no other clear causal indication for this, SBP may be suspected.[12]

These symptoms can also be the same for a spontaneous fungal peritonitis (SFP) and therefore make a differentiation difficult. Delay of diagnosis can delay antifungal treatment and lead to a higher mortality rate.[10]

Causes

SBP is most commonly caused by gram-negative E. coli, followed by Klebsiella. Common gram-positive bacteria identified, include species of Streptococcus and Staphylococcus. The percentage of gram-positive bacteria responsible has been increasing.[7]

A spontaneous fungal infection can often follow a spontaneous bacterial infection that has been treated with antibiotics.[10] The use of antibiotics can result in an excessive growth of fungi in the gut flora which can then translocate into the peritoneal cavity.[11][10] Although fungi are much larger than bacteria, the increased intestinal permeability resulting from advanced cirrhosis makes their translocation easier.[10] SFP is mostly caused by species of Candida and most commonly by Candida albicans.[11]

Pathophysiology

H2 antagonists and proton-pump inhibitors are medications that decrease or suppress the secretion of acid by the stomach. Their use in treating cirrhosis is associated with the development of SBP.[12][13][14] Bacterial translocation is thought to be the key mechanism for the development of SBP.[15][16] Small intestinal bacterial overgrowth which may be implicated in this translocation, is found in a large percentage of those with cirrhosis.[17]

With respect to compromised host defenses, patients with severe acute or chronic liver disease are often deficient in complement and may also have malfunctioning of the neutrophilic and reticuloendothelial systems.[18]

As for the significance of ascitic fluid proteins, it was demonstrated that cirrhotic patients with ascitic protein concentrations below 1 g/dL were 10 times more likely to develop SBP than individuals with higher concentrations.[19] It is thought that the antibacterial, or opsonic, activity of ascitic fluid is closely correlated with the protein concentration.[20] Additional studies have confirmed the validity of the ascitic fluid protein concentration as the best predictor of the first episode of SBP.[18]

In nephrotic syndrome SBP can frequently affect children but only very rarely can it affect adults.[21]

Diagnosis

Infection of the peritoneum causes an inflammatory reaction with a subsequent increase in the number of neutrophils in the fluid.[5] Diagnosis is made by paracentesis (needle aspiration of the ascitic fluid). SBP is diagnosed if the fluid contains neutrophils (a type of white blood cell) at greater than 250 cells per mm3 (equals a cell count of 250 x106/L) fluid in the absence of another reason for this (such as inflammation of one of the internal organs or a perforation).[1][22] The fluid is also cultured to identify bacteria. If the sample is sent in a plain sterile container 40% of samples will identify an organism, while if the sample is sent in a bottle with culture medium the sensitivity increases to 72–90%.[22]

Prevention

All people with cirrhosis might benefit from antibiotics (oral fluoroquinolone norfloxacin) if:

  • Ascitic fluid protein <1.0 g/dL.[19] Patients with fluid protein <15 g/L and either Child-Pugh score of at least 9 or impaired renal function may also benefit.[23]
  • Previous SBP[24]

People with cirrhosis admitted to the hospital should receive prophylactic antibiotics if:

  • They have bleeding esophageal varices[25]

Studies on the use of rifaximin in cirrhotic patients, have suggested that its use may be effective in preventing spontaneous bacterial peritonitis.[26][9]

Treatment

Antibiotics

Although there is no high-quality evidence, the third generation cephalosporins are considered the standard empirical treatment for spontaneous bacterial peritonitis in people with cirrhosis.[27] In practice, cefotaxime is the agent of choice for treatment of SBP. After confirmation of SBP, hospital admission is usually advised for observation and intravenous antibiotic therapy. Where there is a risk of kidney malfunction developing in a syndrome called hepatorenal syndrome intravenous albumin is usually administered too. Paracentesis may be repeated after 48 hours to ensure control of infection. After recovery from a single episode of SBP, indefinite prophylactic antibiotics are recommended.[22]

Prokinetics

The addition of a prokinetic drug to an antibiotic regimen reduces the incidence of spontaneous bacterial peritonitis possibly via decreasing small intestinal bacterial overgrowth.[28]

Intravenous albumin

A randomized controlled trial found that intravenous albumin on the day of admission and on hospital day 3 can reduce kidney impairment.[29]

Epidemiology

Patients with ascites underwent routine paracentesis, the incidence of active SBP ranged from 10% to 27% at the time of hospital admission.[30]

History

SBP was first described in 1964 by Harold O. Conn.[31]

References

1. ^1 2 3 {{cite journal |vauthors=Lata J, Stiburek O, Kopacova M | title = Spontaneous bacterial peritonitis: a severe complication of liver cirrhosis | journal = World J. Gastroenterol. | volume = 15 | issue = 44 | pages = 5505–10 |date=November 2009 | pmid = 19938187 | pmc = 2785051 | doi = 10.3748/wjg.15.5505| url = http://www.wjgnet.com/1007-9327/15/5505.asp | issn = }}
2. ^{{cite journal |last1=Alaniz |first1=C |last2=Regal |first2=RE |title=Spontaneous bacterial peritonitis: a review of treatment options. |journal=P & T : A Peer-reviewed Journal for Formulary Management |date=April 2009 |volume=34 |issue=4 |pages=204–10 |pmid=19561863|pmc=2697093 }}
3. ^{{cite journal |vauthors=Hingorani SR, Weiss NS, Watkins SL | title = Predictors of peritonitis in children with nephrotic syndrome | journal = Pediatr. Nephrol. | volume = 17 | issue = 8 | pages = 678–82 |date=August 2002 | pmid = 12185481 | doi = 10.1007/s00467-002-0890-6 }}
4. ^{{cite journal|last1=Teo|first1=S|last2=Walker|first2=A|last3=Steer|first3=A|title=Spontaneous bacterial peritonitis as a presenting feature of nephrotic syndrome|journal=Journal of Paediatrics and Child Health|date=December 2013|volume=49|issue=12|pages=1069–71|doi=10.1111/jpc.12389|pmid=24118585|type=Review}}
5. ^1 {{cite journal |last1=MacIntosh |first1=T |title=Emergency Management of Spontaneous Bacterial Peritonitis - A Clinical Review. |journal=Cureus |date=1 March 2018 |volume=10 |issue=3 |pages=e2253 |doi=10.7759/cureus.2253 |pmid=29721399|pmc=5929973 }}
6. ^{{cite journal |vauthors=Rimola A, García-Tsao G, Navasa M, etal | title = Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club | journal = J. Hepatol. | volume = 32 | issue = 1 | pages = 142–53 |date=January 2000 | pmid = 10673079 | doi = 10.1016/S0168-8278(00)80201-9| url = http://linkinghub.elsevier.com/retrieve/pii/S0168827800802019 | issn = }}
7. ^1 2 {{cite journal|last1=Dever|first1=JB|last2=Sheikh|first2=MY|title=Review article: spontaneous bacterial peritonitis--bacteriology, diagnosis, treatment, risk factors and prevention|journal=Alimentary Pharmacology & Therapeutics|date=June 2015|volume=41|issue=11|pages=1116–31|doi=10.1111/apt.13172|pmid=25819304|type=Review}}
8. ^{{cite journal |last1=Fernández |first1=J |last2=Bauer |first2=TM |last3=Navasa |first3=M |last4=Rodés |first4=J |title=Diagnosis, treatment and prevention of spontaneous bacterial peritonitis. |journal=Baillière's Best Practice & Research. Clinical Gastroenterology |date=December 2000 |volume=14 |issue=6 |pages=975–990 |doi=10.1053/bega.2000.0142 |pmid=11139350}}
9. ^1 {{cite journal |last1=Fukui |first1=H |last2=Kawaratani |first2=H |last3=Kaji |first3=K |last4=Takaya |first4=H |last5=Yoshiji |first5=H |title=Management of refractory cirrhotic ascites: challenges and solutions. |journal=Hepatic Medicine: Evidence and Research |date=2018 |volume=10 |pages=55–71 |doi=10.2147/HMER.S136578 |pmid=30013405|pmc=6039068 }}
10. ^1 2 3 4 {{cite journal |last1=Shizuma |first1=T |title=Spontaneous bacterial and fungal peritonitis in patients with liver cirrhosis: A literature review. |journal=World Journal of Hepatology |date=27 February 2018 |volume=10 |issue=2 |pages=254–266 |doi=10.4254/wjh.v10.i2.254 |pmid=29527261|pmc=5838444 }}
11. ^1 {{cite journal |last1=Fiore |first1=M |last2=Leone |first2=S |title=Spontaneous fungal peritonitis: Epidemiology, current evidence and future prospective. |journal=World Journal of Gastroenterology |date=14 September 2016 |volume=22 |issue=34 |pages=7742–7 |doi=10.3748/wjg.v22.i34.7742 |pmid=27678356|pmc=5016373 }}
12. ^{{cite journal |vauthors=Gati GA, Deshpande A | title = Increased rate of spontaneous bacterial peritonitis among cirrhotic patients receiving pharmacologic acid suppression | journal = Clinical Gastroenterology and Hepatology | volume = 10 | pages = 422–27 | year = 2012 | pmid = 22155557 | url = | issn = | doi=10.1016/j.cgh.2011.11.019 | issue=4}}
13. ^{{cite journal |vauthors=Deshpande A, Pasupuleti V | title = Acid suppressive therapy is associated with spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis | journal = Journal of Gastroenterology and Hepatology | doi= 10.1111/jgh.12065 | year = 2012 | pmid = 23190338 | url = | issn = | volume=28 | issue=2 | pages=235–42}}
14. ^{{cite journal |vauthors=Bajaj JS, Zadvornova Y | title = Association of Proton Pump Inhibitor Therapy With Spontaneous Bacterial Peritonitis in Cirrhotic Patients With Ascites | journal = American Journal of Gastroenterology | volume = 104 | pages = 1130–34 | year = 2009 | pmid = 19337238 | url = | issn = | doi=10.1038/ajg.2009.80 | issue=5}}
15. ^1 {{cite journal |last1=Koulaouzidis |first1=A |last2=Bhat |first2=S |last3=Saeed |first3=AA |title=Spontaneous bacterial peritonitis. |journal=World Journal of Gastroenterology |date=7 March 2009 |volume=15 |issue=9 |pages=1042–9 |pmid=19266595|pmc=2655193 }}
16. ^{{cite journal |last1=Căruntu |first1=FA |last2=Benea |first2=L |title=Spontaneous bacterial peritonitis: pathogenesis, diagnosis, treatment. |journal=Journal of Gastrointestinal and Liver Diseases : JGLD |date=March 2006 |volume=15 |issue=1 |pages=51–6 |pmid=16680233}}
17. ^{{cite journal |last1=Maslennikov |first1=R |last2=Pavlov |first2=C |last3=Ivashkin |first3=V |title=Small intestinal bacterial overgrowth in cirrhosis: systematic review and meta-analysis. |journal=Hepatology international |date=4 October 2018 |doi=10.1007/s12072-018-9898-2 |pmid=30284684}}
18. ^1 {{cite journal |vauthors=Alaniz C, Regal RE | title = Spontaneous Bacterial Peritonitis: A Review of Treatment Options | journal = P T | volume = 34 | issue = 4 | pages = 204–210 |date=April 2009 | pmid = 19561863 | pmc = 2697093 | doi = | url = | issn = }}
19. ^1 {{cite journal | author = Runyon BA | title = Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis | journal = Gastroenterology | volume = 91 | issue = 6 | pages = 1343–6 |date=December 1986 | pmid = 3770358 | doi = | url = | issn = }}
20. ^{{cite journal |vauthors=Runyon BA, Morrissey RL, Hoefs JC, Wyle FA | title = Opsonic activity of human ascitic fluid: a potentially important protective mechanism against spontaneous bacterial peritonitis | journal = Hepatology | volume = 5 | issue = 4 | pages = 634–7 | year = 1985 | pmid = 4018735 | doi = 10.1002/hep.1840050419| url = | issn = }}
21. ^{{cite journal |last1=Ruiz |first1=S |last2=Soto |first2=S |last3=Rodado |first3=R |last4=Alcaraz |first4=F |last5=López Guillén |first5=E |title=[Spontaneous bacterial peritonitis as form of presentation of idiophatic nephrotic syndrome in a black adult]. |journal=Anales de Medicina Interna (Madrid, Spain : 1984) |date=September 2007 |volume=24 |issue=9 |pages=442–4 |pmid=18198954}}
22. ^1 2 3 4 {{cite journal |vauthors=Moore KP, Aithal GP |title=Guidelines on the management of ascites in cirrhosis |journal=Gut |volume=55| issue=Suppl 6|pages=vi1–12 |date=October 2006 |pmid=16966752 |pmc=1860002 |doi=10.1136/gut.2006.099580 |url=http://gut.bmj.com/content/55/suppl_6/vi1.full}}
23. ^{{cite journal |vauthors=Fernández J, Navasa M, Planas R, etal |title=Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis |journal=Gastroenterology |volume=133 |issue=3 |pages=818–24 |year=2007 |pmid=17854593 |doi=10.1053/j.gastro.2007.06.065}}
24. ^{{cite journal |vauthors=Grangé JD, Roulot D, Pelletier G, etal |title=Norfloxacin primary prophylaxis of bacterial infections in cirrhotic patients with ascites: a double-blind randomized trial |journal=J. Hepatol. |volume=29 |issue=3 |pages=430–6 |year=1998 |pmid=9764990 |doi=10.1016/S0168-8278(98)80061-5}}
25. ^{{Cite journal|last=Chavez-Tapia|first=Norberto C.|last2=Barrientos-Gutierrez|first2=Tonatiuh|last3=Tellez-Avila|first3=Felix I.|last4=Soares-Weiser|first4=Karla|last5=Uribe|first5=Misael|date=2010-09-08|title=Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding|journal=The Cochrane Database of Systematic Reviews|issue=9|pages=CD002907|doi=10.1002/14651858.CD002907.pub2|issn=1469-493X|pmid=20824832}}
26. ^{{cite journal |last1=Goel |first1=A |last2=Rahim |first2=U |last3=Nguyen |first3=LH |last4=Stave |first4=C |last5=Nguyen |first5=MH |title=Systematic review with meta-analysis: rifaximin for the prophylaxis of spontaneous bacterial peritonitis. |journal=Alimentary Pharmacology & Therapeutics |date=December 2017 |volume=46 |issue=11–12 |pages=1029–1036 |doi=10.1111/apt.14361 |pmid=28994123}}
27. ^{{cite journal|last1=Chavez-Tapia|first1=NC|last2=Soares-Weiser|first2=K|last3=Brezis|first3=M|last4=Leibovici|first4=L|title=Antibiotics for spontaneous bacterial peritonitis in cirrhotic patients.|journal=The Cochrane Database of Systematic Reviews|date=21 January 2009|issue=1|pages=CD002232|doi=10.1002/14651858.CD002232.pub2|pmid=19160207}}
28. ^{{Cite journal | last1 = Hiyama | first1 = T. | last2 = Yoshihara | first2 = M. | last3 = Tanaka | first3 = S. | last4 = Haruma | first4 = K. | last5 = Chayama | first5 = K. | title = Effectiveness of prokinetic agents against diseases external to the gastrointestinal tract. | journal = J Gastroenterol Hepatol | volume = 24 | issue = 4 | pages = 537–46 |date=Apr 2009 | doi = 10.1111/j.1440-1746.2009.05780.x | pmid = 19220673 }}
29. ^{{cite journal |vauthors=Sort P, Navasa M, Arroyo V, etal |title=Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis |journal=N. Engl. J. Med. |volume=341 |issue=6 |pages=403–9 |year=1999 |pmid=10432325 |doi=10.1056/NEJM199908053410603}}
30. ^{{cite journal | author = Runyon BA | title = Spontaneous bacterial peritonitis: an explosion of information | journal = Hepatology | volume = 8 | issue = 1 | pages = 171–5 | year = 1988 | pmid = 3338704 | doi = 10.1002/hep.1840080131| url = | issn = }}
31. ^{{cite journal |author=CONN HO |title=Spontaneous peritonitis and bacteremia in Laennec's cirrhosis caused by enteric organisms. A relatively common but rarely recognized syndrome |journal=Ann. Intern. Med. |volume=60 |issue= 4|pages=568–80 |date=April 1964 |pmid=14138877 |doi= 10.7326/0003-4819-60-4-568|url=http://www.annals.org/content/60/4/568.full.pdf | format=PDF}}

External links

{{Medical resources
| ICD10 =
| ICD9 = {{ICD9|567.23}}
| eMedicineSubj = emerg
| eMedicineTopic = 882
}}{{Gastroenterology}}{{DEFAULTSORT:Spontaneous Bacterial Peritonitis}}

1 : Peritoneum disorders
随便看

　

开放百科全书收录14589846条英语、德语、日语等多语种百科知识，基本涵盖了大多数领域的百科知识，是一部内容自由、开放的电子版国际百科全书。

　

Copyright © 2023 OENC.NET All Rights Reserved
京ICP备2021023879号 更新时间：2024/9/20 8:12:22