Spontaneous bacterial peritonitis

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  • Gram negative organisms
  • Intestinal bacterial translocation or hematogenous spread

Presentation

  • Fever
  • Abdominal pain
  • Altered mental status
  • Hypotension, hypothermia or paralytic ileus when severe

Diagnosis

Paracentesis:

  • >250PMN in ascetic fluid, positive culture, exclusion of other causes
  • Serum-ascites albumin gradient >1.1
  • Ascites protein <1 and glucose >50

Treatment

  • Empiric: 3rd generation cephalosporins (cefotaxime)
  • Prophylaxis:Fluoroquinolones