Spontaneous bacterial peritonitis classification: Difference between revisions
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| 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. | | 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. | ||
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=== Classification Based on Clinical Setting === | |||
Based on ascitic fluid analysis Peritonitis 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> | |||
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! '''Clinical varient of Spontaneous bacterial peritonitis''' !! '''Explanation''' | |||
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| '''Health care-associated SBP (HCA)''' | |||
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* 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 centres and other health care setting). | |||
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| '''Nosocomial SBP''' | |||
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* Diagnosis of peritonitis 48 hours after the hospital admission. | |||
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| '''Community acquired SBP (CA)''' | |||
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* Diagnosis of peritonitis within 48 hours of hospital admission, but no history of prior health care contact in the past 90 days. | |||
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| '''Multi-drug resistant SBP''' | |||
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* Associate with prior history of antibiotic exposure and treat peritonitis based on culture sensitivities. | |||
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| '''Recurrent SBP''' | |||
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* Recurrent episodes of peritonitis increases risk of mortality compared to first episode mortality of SBP. Prophylactic antibiotics can reduce the mortality. | |||
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==References== | ==References== | ||
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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]
- 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 pearls | |
| 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 ascitic fluid analysis Peritonitis is classified as follows:[2]
| Clinical varient of Spontaneous bacterial peritonitis | Explanation |
|---|---|
| Health care-associated SBP (HCA) |
|
| Nosocomial SBP |
|
| Community acquired SBP (CA) |
|
| Multi-drug resistant SBP |
|
| Recurrent SBP |
|
References
- ↑ Sheer TA, Runyon BA (2005). "Spontaneous bacterial peritonitis". Dig Dis. 23 (1): 39–46. doi:10.1159/000084724. PMID 15920324.
- ↑ 2.0 2.1 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, 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.
- ↑ 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.