Spontaneous Bacterial Peritonitis (SBP)

Spontaneous bacterial peritonitis (SBP) is defined as an infection of ascites fluid, typically in the setting of bacterial gut translocation in patients with cirrhosis and ascites, and without another explanation for peritonitis. SBP is a major source of morbidity and mortality among patients with cirrhosis and requires a high clinical suspicion by the treating practitioner followed by diagnostic paracentesis and prompt initiation of antibiotics to prevent complications. This chapter reviews the pathogenesis and precipitating risk factors leading to the development of SBP, followed by a discussion of clinical presentation and diagnostic evaluation for patients suspected of having SBP. The remainder of the chapter focuses on treatment principles for an acute episode of SBP as well as strategies and guidelines for patients at high risk of SBP who may benefit from prophylaxis.