Spontaneous Bacterial Peritonitis Flashcards

1
Q

SBP definition

A

bacterial infection of the ascitic fluid of the peritoneum

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2
Q

What organisms usually SBP

A

Enteric gram negatives (e.coli, K.pneumonia)

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3
Q

Frequent cause of death for cirrhotic patients

A

SBP

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4
Q

Diagnosing SBP

A

Signs and symptoms
Paracentesis show absolute PMN ≥250

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5
Q

Signs and symptoms of SBP

A

fever, malaise, weakness
elevated WBC
abdominal pain, tenderness

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6
Q

Absolute polymorphonucleated leukocyte calculation

A

WBC in ascitic fluid x %PMN

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7
Q

Why don’t we wait for bacterial culture results before treating?

A

Takes 72 hours for results

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8
Q

How soon can we get the APMN WBC count?

A

same day

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9
Q

Treatment of SBP - active infection

A

Empiric antibiotic: 3rd gen cephalosporin x 5 days
- if allergy, use ciprofloxacin
- Once culture results out: pathogen-directed therapy

IV albumin for patients that qualify
1.5 g/kg on day 1
1 g/kg on day 3

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10
Q

What patients qualify for IV albumin in SBP?

A

Any one of the following
SCr>1
Bilirubin > 4
BUN > 30

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11
Q

After starting antibiotics, how soon do you repeat a paracentesis?

A

48 hours after starting abx
- check for ESBL
- may need to escalate therapy
- check if at goal

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12
Q

What is the goal of abx therapy in SBP?

A

Drop PMW >25% from baseline
if not at goal, broaden coverage
- ESBL? –>use carbapenems
Reset day count, 5 days of the new drug

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13
Q

SBP treatment – prophylaxis

A

For anyone with acute variceal bleeding, and especially after SBP
7 days of IV ceftriaxone or cipro if allergic

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