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Current Hepatology Reports

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01-12-2020 | Bacterial Peritonitis | Management of Cirrhotic Patient (A Cardenas and P Tandon, Section Editors)

Spontaneous Bacterial Peritonitis and Secondary Bacterial Peritonitis—a Comprehensive Review

Authors: Gabriela Kuftinec, Jose Raul Estrada, Kalyan Ram Bhamidimarri

Published in: Current Hepatology Reports | Issue 4/2020

Abstract

Purpose of Review

Spontaneous bacterial peritonitis (SBP) and secondary bacterial peritonitis are life-threatening complications of cirrhosis if not recognized immediately and managed appropriately. SBP occurs in ~ 3.5 to 10% of patients with cirrhosis and ascites, whereas secondary bacterial peritonitis occurs in 5%. Prompt recognition of SBP variants is vital for tailoring therapy to decrease mortality rate from 90 to 20%. Our objective is to provide an update on the recent publications to elucidate the variants of SBP and provide a management algorithm for the potentially life-threatening complications of cirrhosis.

Recent Findings

The general guidelines for the management of spontaneous bacterial peritonitis are mostly unchanged, but there are newer data regarding trends in bacteriology and pathogens and newer prophylactic strategies. Spontaneous fungal peritonitis, spontaneous bacterial empyema, and secondary bacterial peritonitis can be clinically challenging if not diagnosed promptly. Nutrition is an under-recognized but important aspect of the management of ascites and SBP prevention. Emerging options for the management of diuretic refractory ascites and infection management are discussed in detail.

Summary

Early diagnosis and treatment of SBP and secondary bacterial peritonitis are usually associated with good outcomes, but mortality remains as high as 40%. There is a higher risk of other decompensating cirrhotic events after the initial episode of SBP or secondary bacterial peritonitis that portends poor prognosis. The emphasis should be to identify the precipitating cause and focus on the modifiable risk factors to improve outcomes and survival. Newer strategies for SBP prophylaxis and ascites management appear promising until liver transplantation. Personalized approach is crucial to improve the morbidity, quality of life, and mortality in every patient with decompensated cirrhosis.

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Title: Spontaneous Bacterial Peritonitis and Secondary Bacterial Peritonitis—a Comprehensive Review
Authors: Gabriela Kuftinec
Jose Raul Estrada
Kalyan Ram Bhamidimarri
Publication date: 01-12-2020
Publisher: Springer US
Keywords: Bacterial Peritonitis
Peritonitis
Ascites
Published in: Current Hepatology Reports / Issue 4/2020
Electronic ISSN: 2195-9595
DOI: https://doi.org/10.1007/s11901-020-00551-9

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