Spontaneous bacterial peritonitis (SBP)
- Occurs in the setting of cirrhosis or nephrotic syndrome, but can rarely occur in healthy children, especially school age girls.
- Spontaneous bacterial peritonitis is usually monomicrobial. Polymicrobial infections suggest bowel perforation. See 2° peritonitis.
Diagnosis:
- Ascitic fluid positive for bacteria and PMNs ≥ 0.25 x 109/L.
- Blood/peritoneal fluid cultures recommended.
Management:
- Urinary/intravascular catheterization may increase risk of infection in patients with ascites - avoid if possible.
- Aminoglycosides should be avoided in patients with cirrhosis.
- Increased risk of SBP (and Clostridioides (Clostridium) difficile infection) in cirrhotic patients on proton pump inhibitors (PPIs). Therefore use PPIs judiciously and only when clearly indicated in cirrhotic patients.
S. pneumoniae
Group A Streptococci
Enterobacterales