Spontaneous bacterial peritonitis classification: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Spontaneous bacterial peritonitis}} | {{Spontaneous bacterial peritonitis}} | ||
{{CMG}} ; {{AE}} {{ADI}} | {{CMG}} ; {{AE}} {{ADI}} {{SCh}} {{AY}} | ||
==Overview== | ==Overview== | ||
[[Spontaneous bacterial peritonitis]] is one variant of [[Ascites|ascitic fluid]] [[infections]].<ref name="pmid15920324">{{cite journal| author=Sheer TA, Runyon BA| title=Spontaneous bacterial peritonitis. | journal=Dig Dis | year= 2005 | volume= 23 | issue= 1 | pages= 39-46 | pmid=15920324 | doi=10.1159/000084724 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15920324 }} </ref> Classification of ascitic fluid infections is based on [[neutrophil]] count and [[Growth medium|culture]] report.<ref name="pmid25819304">Dever JB, Sheikh MY (2015) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=25819304 Review article: spontaneous bacterial peritonitis--bacteriology, diagnosis, treatment, risk factors and prevention.] ''Aliment Pharmacol Ther'' 41 (11):1116-31. [http://dx.doi.org/10.1111/apt.13172 DOI:10.1111/apt.13172] PMID: [https://pubmed.gov/25819304 25819304]</ref><ref name="pmid19475696">{{cite journal| author=Runyon BA, AASLD Practice Guidelines Committee| title=Management of adult patients with ascites due to cirrhosis: an update. | journal=Hepatology | year= 2009 | volume= 49 | issue= 6 | pages= 2087-107 | pmid=19475696 | doi=10.1002/hep.22853 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19475696 }} </ref> Asymptomatic bacterascites is usually the transient residence of bacteria in ascitic fluid without clinical features of [[peritonitis]] or increased [[Ascites|ascitic fluid]] [[polymorphonuclear cells]].<ref name="pmid2066060">{{cite journal| author=Pelletier G, Lesur G, Ink O, Hagege H, Attali P, Buffet C et al.| title=Asymptomatic bacterascites: is it spontaneous bacterial peritonitis? | journal=Hepatology | year= 1991 | volume= 14 | issue= 1 | pages= 112-5 | pmid=2066060 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2066060 }} </ref> SBP is also classified based on the routes of [[infection]] and the clinical setting as follows [[health care]]-associated, [[nosocomial]], community acquired, [[multi-drug resistant]] and recurrent. | |||
==Classification== | ==Classification== | ||
* Spontaneous bacterial peritonitis is one of the variants of ascitic fluid infections.<ref name="pmid15920324">{{cite journal| author=Sheer TA, Runyon BA| title=Spontaneous bacterial peritonitis. | journal=Dig Dis | year= 2005 | volume= 23 | issue= 1 | pages= 39-46 | pmid=15920324 | doi=10.1159/000084724 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15920324 }} </ref> | * [[SBP|Spontaneous bacterial peritonitis]] is one of the variants of [[Ascites|ascitic fluid]] [[Infection|infections]].<ref name="pmid15920324">{{cite journal| author=Sheer TA, Runyon BA| title=Spontaneous bacterial peritonitis. | journal=Dig Dis | year= 2005 | volume= 23 | issue= 1 | pages= 39-46 | pmid=15920324 | doi=10.1159/000084724 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15920324 }} </ref> | ||
* Classification of ascitic fluid infections is based on neutrophil count and culture report.<ref name="pmid25819304">Dever JB, Sheikh MY (2015) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=25819304 Review article: spontaneous bacterial peritonitis--bacteriology, diagnosis, treatment, risk factors and prevention.] ''Aliment Pharmacol Ther'' 41 (11):1116-31. [http://dx.doi.org/10.1111/apt.13172 DOI:10.1111/apt.13172] PMID: [https://pubmed.gov/25819304 25819304]</ref><ref name="pmid19475696">{{cite journal| author=Runyon BA, AASLD Practice Guidelines Committee| title=Management of adult patients with ascites due to cirrhosis: an update. | journal=Hepatology | year= 2009 | volume= 49 | issue= 6 | pages= 2087-107 | pmid=19475696 | doi=10.1002/hep.22853 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19475696 }} </ref> | * Classification of [[Ascites|ascitic fluid]] infections is based on [[Neutrophil|neutrophil count]] and [[Culture medium|culture]] report.<ref name="pmid25819304">Dever JB, Sheikh MY (2015) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=25819304 Review article: spontaneous bacterial peritonitis--bacteriology, diagnosis, treatment, risk factors and prevention.] ''Aliment Pharmacol Ther'' 41 (11):1116-31. [http://dx.doi.org/10.1111/apt.13172 DOI:10.1111/apt.13172] PMID: [https://pubmed.gov/25819304 25819304]</ref><ref name="pmid19475696">{{cite journal| author=Runyon BA, AASLD Practice Guidelines Committee| title=Management of adult patients with ascites due to cirrhosis: an update. | journal=Hepatology | year= 2009 | volume= 49 | issue= 6 | pages= 2087-107 | pmid=19475696 | doi=10.1002/hep.22853 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19475696 }} </ref> | ||
* Asymptomatic bacterascites is usually the transient residence of bacteria in ascitic fluid without clinical features of peritonitis or increased ascitic fluid polymorphonuclear cells.<ref name="pmid2066060">{{cite journal| author=Pelletier G, Lesur G, Ink O, Hagege H, Attali P, Buffet C et al.| title=Asymptomatic bacterascites: is it spontaneous bacterial peritonitis? | journal=Hepatology | year= 1991 | volume= 14 | issue= 1 | pages= 112-5 | pmid=2066060 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2066060 }} </ref> | * [[Asymptomatic]] bacterascites is usually the transient residence of bacteria in [[Ascites|ascitic]] fluid without clinical features of [[peritonitis]] or increased [[Ascites|ascitic fluid]] [[polymorphonuclear cells]].<ref name="pmid2066060">{{cite journal| author=Pelletier G, Lesur G, Ink O, Hagege H, Attali P, Buffet C et al.| title=Asymptomatic bacterascites: is it spontaneous bacterial peritonitis? | journal=Hepatology | year= 1991 | volume= 14 | issue= 1 | pages= 112-5 | pmid=2066060 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2066060 }} </ref> | ||
{| | {| | ||
|- style="background:silver; color:black" | |- style="background:silver; color:black" | ||
| Culture negative neutrocytic ascites (CNNA)<ref name="pmid2365982">{{cite journal| author=Pelletier G, Salmon D, Ink O, Hannoun S, Attali P, Buffet C et al.| title=Culture-negative neutrocytic ascites: a less severe variant of spontaneous bacterial peritonitis. | journal=J Hepatol | year= 1990 | volume= 10 | issue= 3 | pages= 327-31 | pmid=2365982 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2365982 }} </ref><ref name="pmid6500513">{{cite journal| author=Runyon BA, Hoefs JC| title=Culture-negative neutrocytic ascites: a variant of spontaneous bacterial peritonitis. | journal=Hepatology | year= 1984 | volume= 4 | issue= 6 | pages= 1209-11 | pmid=6500513 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6500513 }} </ref>|| Negative || ≥250 || Poor culture technique and prior antibiotics or low opsonic activity in ascitic fluid. Commonly encountered phenotype and requires antibiotic therapy | ! '''Type of [[Infection]]''' !! '''[[Growth medium|Bacterial Culture]] Report''' !! '''[[Ascitic|Ascitic fluid analysis]] [[Neutrophil]] Count (cells/mm<sup>3</sup>)''' !! '''Clinical aspects''' !! | ||
|- style="background:silver; color:black" | |||
| align="center" | [[SBP|Spontaneous bacterial peritonitis]]<ref name="pmid19845823">{{cite journal| author=Kim SU, Kim DY, Lee CK, Park JY, Kim SH, Kim HM et al.| title=Ascitic fluid infection in patients with [[hepatitis B]] virus-related liver [[cirrhosis]]: culture-negative neutrocytic ascites versus spontaneous bacterial [[peritonitis]]. | journal=J Gastroenterol Hepatol | year= 2010 | volume= 25 | issue= 1 | pages= 122-8 | pmid=19845823 | doi=10.1111/j.1440-1746.2009.05970.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19845823 }} </ref> || align="center" | Positive usually for one [[organism]] || align="center" |≥250 ||Patients with [[cirrhosis]] and [[ascites]] in the presence or absence of symptoms and signs | |||
|- style="background:silver; color:black" | |||
| align="center" | Culture negative neutrocytic ascites (CNNA)<ref name="pmid2365982">{{cite journal| author=Pelletier G, Salmon D, Ink O, Hannoun S, Attali P, Buffet C et al.| title=Culture-negative neutrocytic ascites: a less severe variant of spontaneous bacterial peritonitis. | journal=J Hepatol | year= 1990 | volume= 10 | issue= 3 | pages= 327-31 | pmid=2365982 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2365982 }} </ref><ref name="pmid6500513">{{cite journal| author=Runyon BA, Hoefs JC| title=Culture-negative neutrocytic ascites: a variant of spontaneous bacterial peritonitis. | journal=Hepatology | year= 1984 | volume= 4 | issue= 6 | pages= 1209-11 | pmid=6500513 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6500513 }} </ref>|| align="center" | Negative || align="center" | ≥250 || Poor [[Growth medium|culture]] technique and prior [[Antibiotic|antibiotics]] or low [[Opsonin|opsonic]] activity in ascitic fluid. Commonly encountered [[phenotype]] and requires [[antibiotic therapy]]. | |||
|- style="background:silver; color:black" | |- style="background:silver; color:black" | ||
| Monomicrobial bacterascites<ref name="pmid2210672">{{cite journal| author=Runyon BA| title=Monomicrobial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis. | journal=Hepatology | year= 1990 | volume= 12 | issue= 4 Pt 1 | pages= 710-5 | pmid=2210672 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2210672 }} </ref> || Positive for one organism || <250 || Ascitic fluid infection which may resolve spontaneously or progress to SBP. Mortality is similar to SBP and should be treated as SBP. | | align="center" | Monomicrobial bacterascites<ref name="pmid2210672">{{cite journal| author=Runyon BA| title=Monomicrobial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis. | journal=Hepatology | year= 1990 | volume= 12 | issue= 4 Pt 1 | pages= 710-5 | pmid=2210672 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2210672 }} </ref> || align="center" | Positive for one organism || align="center" | <250 || Ascitic fluid infection which may resolve spontaneously or progress to SBP. [[Mortality]] is similar to SBP and should be treated as SBP. | ||
|- style="background:silver; color:black" | |- style="background:silver; color:black" | ||
| Secondary bacterial peritonitis || Positive for many microbes || ≥250 || Intraperitoneal source of infection e.g. diverticulitis | | align="center" | Secondary bacterial [[peritonitis]] || align="center" | Positive for many microbes || align="center" | ≥250 || [[Intraperitoneal]] source of infection e.g. [[diverticulitis]] | ||
|- style="background:silver; color:black" | |- style="background:silver; color:black" | ||
| Polymicrobial bacterascites<ref name="pmid3778046">{{cite journal| author=Runyon BA, Hoefs JC, Canawati HN| title=Polymicrobial bacterascites. A unique entity in the spectrum of infected ascitic fluid. | journal=Arch Intern Med | year= 1986 | volume= 146 | issue= 11 | pages= 2173-5 | pmid=3778046 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3778046 }} </ref> || Positive for many microbes || <250 || Usually due to bowel perforation by the paracentesis needle and reflects growth of gut flora before the ascitic fluid can mount a neutrocytic response. | | align="center" | Polymicrobial bacterascites<ref name="pmid3778046">{{cite journal| author=Runyon BA, Hoefs JC, Canawati HN| title=Polymicrobial bacterascites. A unique entity in the spectrum of infected ascitic fluid. | journal=Arch Intern Med | year= 1986 | volume= 146 | issue= 11 | pages= 2173-5 | pmid=3778046 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3778046 }} </ref> || align="center" | Positive for many microbes || align="center" | <250 || Usually due to [[bowel perforation]] by the [[paracentesis]] needle and reflects growth of [[gut flora]] before the ascitic fluid can mount a neutrocytic response. | ||
|} | |} | ||
=== Classification Based on Clinical Setting === | === Classification Based on Clinical Setting === | ||
Based on | Based on the route of infection SBP is classified as follows:<ref name="pmid25819304">Dever JB, Sheikh MY (2015) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=25819304 Review article: spontaneous bacterial peritonitis--bacteriology, diagnosis, treatment, risk factors and prevention.] ''Aliment Pharmacol Ther'' 41 (11):1116-31. [http://dx.doi.org/10.1111/apt.13172 DOI:10.1111/apt.13172] PMID: [https://pubmed.gov/25819304 25819304]</ref><ref name="Fernández2002">{{cite journal|last1=Fernández|first1=J|title=Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis|journal=Hepatology|volume=35|issue=1|year=2002|pages=140–148|issn=02709139|doi=10.1053/jhep.2002.30082}}</ref> | ||
{| | |||
! '''Clinical | {| style="margin: 1em 1em 1em 0; background: #f9f9f9; border: 1px #aaa solid; border-collapse: collapse;" width="75%" cellspacing="0" cellpadding="4" border="2" | ||
! '''Clinical setting associated with SBP''' !! Criteria | |||
|- | |- | ||
| '''Health care-associated SBP (HCA)''' | | '''Health care-associated SBP (HCA)''' | ||
| | | | ||
* Diagnosis of peritonitis within 48 hours of hospital admission in patients with any prior health care contact in the past 90 days (e.g. recent hospitalisation, nursing home, dialysis | * Diagnosis of [[peritonitis]] within 48 hours of hospital admission in patients with any prior health care contact in the past 90 days (e.g. recent hospitalisation, nursing home, [[dialysis]] centers and other health care setting) | ||
|- | |- | ||
| '''Nosocomial SBP''' | | '''[[Nosocomial|Nosocomial SBP]]''' | ||
| | | | ||
* Diagnosis of peritonitis 48 hours after the hospital admission. | * Diagnosis of [[peritonitis]] 48 hours after the hospital admission. | ||
* Predominantly caused by [[gram-positive cocci]] | |||
|- | |- | ||
| '''Community acquired SBP (CA)''' | | '''Community acquired SBP (CA)''' | ||
| | | | ||
* Diagnosis of peritonitis within 48 hours of hospital admission, but no history of prior health care contact in the past 90 days. | * Diagnosis of [[peritonitis]] within 48 hours of hospital admission, but no history of prior health care contact in the past 90 days. Predominantly caused by [[gram-negative]] bacteria. | ||
|- | |- | ||
| '''Multi-drug resistant SBP''' | | '''[[Multi-drug resistant]] SBP''' | ||
| | | | ||
* | * Associated with prior history of [[antibiotic]] exposure. Treatment of [[peritonitis]] is based on [[Culture medium|culture]][[sensitivity|sandensitivity]] | ||
|- | |- | ||
| '''Recurrent SBP''' | | '''Recurrent SBP''' | ||
| | | | ||
* Recurrent episodes of peritonitis increases risk of mortality compared to first episode mortality of SBP | * Recurrent episodes of peritonitis increases risk of [[Mortality rate|mortality]] compared to first episode mortality of SBP | ||
* [[Antibiotics|Prophylactic antibiotics]] can reduce the mortality | |||
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[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
Latest revision as of 00:14, 30 July 2020
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Spontaneous bacterial peritonitis Microchapters |
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Differentiating Spontaneous bacterial peritonitis from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Shivani Chaparala M.B.B.S [3] Ahmed Younes M.B.B.CH [4]
Overview
Spontaneous bacterial peritonitis is one variant of ascitic fluid infections.[1] Classification of ascitic fluid infections is based on neutrophil count and culture report.[2][3] Asymptomatic bacterascites is usually the transient residence of bacteria in ascitic fluid without clinical features of peritonitis or increased ascitic fluid polymorphonuclear cells.[4] SBP is also classified based on the routes of infection and the clinical setting as follows health care-associated, nosocomial, community acquired, multi-drug resistant and recurrent.
Classification
- Spontaneous bacterial peritonitis is one of the variants of ascitic fluid infections.[1]
- Classification of ascitic fluid infections is based on neutrophil count and culture report.[2][3]
- Asymptomatic bacterascites is usually the transient residence of bacteria in ascitic fluid without clinical features of peritonitis or increased ascitic fluid polymorphonuclear cells.[4]
| Type of Infection | Bacterial Culture Report | Ascitic fluid analysis Neutrophil Count (cells/mm3) | Clinical aspects | |
|---|---|---|---|---|
| Spontaneous bacterial peritonitis[5] | Positive usually for one organism | ≥250 | Patients with cirrhosis and ascites in the presence or absence of symptoms and signs | |
| Culture negative neutrocytic ascites (CNNA)[6][7] | Negative | ≥250 | Poor culture technique and prior antibiotics or low opsonic activity in ascitic fluid. Commonly encountered phenotype and requires antibiotic therapy. | |
| Monomicrobial bacterascites[8] | Positive for one organism | <250 | Ascitic fluid infection which may resolve spontaneously or progress to SBP. Mortality is similar to SBP and should be treated as SBP. | |
| Secondary bacterial peritonitis | Positive for many microbes | ≥250 | Intraperitoneal source of infection e.g. diverticulitis | |
| Polymicrobial bacterascites[9] | Positive for many microbes | <250 | Usually due to bowel perforation by the paracentesis needle and reflects growth of gut flora before the ascitic fluid can mount a neutrocytic response. |
Classification Based on Clinical Setting
Based on the route of infection SBP is classified as follows:[2][10]
| Clinical setting associated with SBP | Criteria |
|---|---|
| Health care-associated SBP (HCA) |
|
| Nosocomial SBP |
|
| Community acquired SBP (CA) |
|
| Multi-drug resistant SBP |
|
| Recurrent SBP |
|
References
- ↑ 1.0 1.1 Sheer TA, Runyon BA (2005). "Spontaneous bacterial peritonitis". Dig Dis. 23 (1): 39–46. doi:10.1159/000084724. PMID 15920324.
- ↑ 2.0 2.1 2.2 Dever JB, Sheikh MY (2015) Review article: spontaneous bacterial peritonitis--bacteriology, diagnosis, treatment, risk factors and prevention. Aliment Pharmacol Ther 41 (11):1116-31. DOI:10.1111/apt.13172 PMID: 25819304
- ↑ 3.0 3.1 Runyon BA, AASLD Practice Guidelines Committee (2009). "Management of adult patients with ascites due to cirrhosis: an update". Hepatology. 49 (6): 2087–107. doi:10.1002/hep.22853. PMID 19475696.
- ↑ 4.0 4.1 Pelletier G, Lesur G, Ink O, Hagege H, Attali P, Buffet C; et al. (1991). "Asymptomatic bacterascites: is it spontaneous bacterial peritonitis?". Hepatology. 14 (1): 112–5. PMID 2066060.
- ↑ Kim SU, Kim DY, Lee CK, Park JY, Kim SH, Kim HM; et al. (2010). "Ascitic fluid infection in patients with [[hepatitis B]] virus-related liver [[cirrhosis]]: culture-negative neutrocytic ascites versus spontaneous bacterial [[peritonitis]]". J Gastroenterol Hepatol. 25 (1): 122–8. doi:10.1111/j.1440-1746.2009.05970.x. PMID 19845823. URL–wikilink conflict (help)
- ↑ Pelletier G, Salmon D, Ink O, Hannoun S, Attali P, Buffet C; et al. (1990). "Culture-negative neutrocytic ascites: a less severe variant of spontaneous bacterial peritonitis". J Hepatol. 10 (3): 327–31. PMID 2365982.
- ↑ Runyon BA, Hoefs JC (1984). "Culture-negative neutrocytic ascites: a variant of spontaneous bacterial peritonitis". Hepatology. 4 (6): 1209–11. PMID 6500513.
- ↑ Runyon BA (1990). "Monomicrobial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis". Hepatology. 12 (4 Pt 1): 710–5. PMID 2210672.
- ↑ Runyon BA, Hoefs JC, Canawati HN (1986). "Polymicrobial bacterascites. A unique entity in the spectrum of infected ascitic fluid". Arch Intern Med. 146 (11): 2173–5. PMID 3778046.
- ↑ Fernández, J (2002). "Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis". Hepatology. 35 (1): 140–148. doi:10.1053/jhep.2002.30082. ISSN 0270-9139.