Spontaneous bacterial peritonitis classification: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
|||
| Line 6: | Line 6: | ||
==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> | * 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> | ||
* 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 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> | ||
* 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 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> | ||
{| | {| | ||
|-style="background:silver; color:black" | |-style="background:silver; color:black" | ||
! '''Type of Infection''' !! '''Bacterial Culture Report''' !! '''Ascitic fluid analysis Neutrophil Count (cells/mm<sup>3</sup>)''' !! '''Clinical pearls''' !! | ! '''Type of Infection''' !! '''Bacterial Culture Report''' !! '''Ascitic fluid analysis [[Neutrophil]] Count (cells/mm<sup>3</sup>)''' !! '''Clinical pearls''' !! | ||
|-style="background:silver; color:black" | |-style="background:silver; color:black" | ||
|align=center| 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 | |align=center| 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" | |- 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 culture technique and prior antibiotics or low opsonic activity in ascitic fluid. Commonly encountered phenotype and requires antibiotic therapy. | |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 culture technique and prior antibiotics or low opsonic activity in ascitic fluid. Commonly encountered phenotype and requires antibiotic therapy. | ||
| Line 20: | Line 20: | ||
|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. | |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" | ||
|align=center| Secondary bacterial peritonitis ||align=center| Positive for many microbes ||align=center| ≥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" | ||
|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. | |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 === | ||
| Line 32: | Line 32: | ||
| '''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]] SBP''' | ||
| | | | ||
* Diagnosis of peritonitis 48 hours after the hospital admission.Predominantly caused by gram-positive cocci. | * 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.Predominantly caused by gram-negative bacteria. | * 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''' | ||
| | | | ||
* Associate with prior history of antibiotic exposure and treat peritonitis based on culture sensitivities. | * Associate with prior history of antibiotic exposure and treat [[peritonitis]] based on culture sensitivities. | ||
|- | |- | ||
| '''Recurrent SBP''' | | '''Recurrent SBP''' | ||
Revision as of 14:58, 23 January 2017
|
Spontaneous bacterial peritonitis Microchapters |
|
Differentiating Spontaneous bacterial peritonitis from other Diseases |
|
Diagnosis |
|
Treatment |
|
Spontaneous bacterial peritonitis classification On the Web |
|
American Roentgen Ray Society Images of Spontaneous bacterial peritonitis classification |
|
Spontaneous bacterial peritonitis classification in the news |
|
Directions to Hospitals Treating Spontaneous bacterial peritonitis |
|
Risk calculators and risk factors for Spontaneous bacterial peritonitis classification |
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]
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 the route of infection SBP is classified as follows:[2][10]
| Clinical setting associated with SBP | 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. 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.