Spontaneous bacterial peritonitis classification: Difference between revisions
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| Spontaneous bacterial peritonitis || Positive usually for one organism || ≥250 || Patients with cirrhosis and ascites in the presence or absence of symptoms and signs | | Spontaneous bacterial peritonitis || Positive usually for one organism || ≥250 || Patients with cirrhosis and ascites in the presence or absence of symptoms and signs | ||
|- style="background:silver; color:black" | |- style="background:silver; color:black" | ||
| Culture negative neutrocytic ascites (CNNA)<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 | | 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 | ||
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| 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. | | 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. | ||
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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]
Overview
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]
| Type of Infection | Bacterial Culture Report | Ascitic fluid analysis Neutrophil Count (cells/mm3) | Clinical pearls | |
| Spontaneous bacterial peritonitis | 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)[4][5] | Negative | ≥250 | Poor culture technique and prior antibiotics or low opsonic activity in ascitic fluid. Commonly encountered phenotype and requires antibiotic therapy | |
| Monomicrobial bacterascites[6] | 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[7] | 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. |
References
- ↑ Sheer TA, Runyon BA (2005). "Spontaneous bacterial peritonitis". Dig Dis. 23 (1): 39–46. doi:10.1159/000084724. PMID 15920324.
- ↑ 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
- ↑ 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.
- ↑ 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.