SPONTANEOUS BACTERIAL PERITONITIS - AN UPDATE

Objective: To describe spontaneous bacterial peritonitis (SEP) in the context of currently accepted criteria for diagnosis, treatment, and prevention. Design: A review of SEP and its associated etiopathogenic factors is presented. Material and Methods: Numerous studies on mechanisms of disease, diagnosis, treatment, and prevention are discussed, Diagnostic and therapeutic algorithms are presented. Results: Peritonitis in patients with ascites in the absence of secondary causes, such as perforation of a viscus, occurs primarily in patients with end-stage liver disease, Enteric organisms, mainly gram-negative bacilli, probably translocate to regional lymph nodes to produce bacteremia and seeding of ascitic fluid, Signs and symptoms of peritonitis are usually subtle, The ascitic fluid polymorphonuclear leukocyte count is the best determinant for early diagnosis and treatment of SEP. Third-generation cephalosporins such as cefotaxime are considered the drugs of choice for treatment, whereas quinolones such as norfloxacin are used to decrease recurrence. Conclusion: Despite increased awareness, early diagnosis, and prompt and effective antimicrobial therapy, SEP recurs frequently and is associated with a high mortality rate, Patients with SEP should be assessed for candidacy for liver transplantation.