Spontaneous bacterial peritonitis classification

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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

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)	Negative	≥250	Poor culture technique and prior antibiotics or low opsonic activity in ascitic fluid. Commonly encountered phenotype and requires antibiotic therapy
Monomicrobial bacterascites	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	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.