Spontaneous Bacterial Peritonitis: Is it Still a Life-Threatening Issue in Cirrhosis?

Spontaneous bacterial peritonitis is the commonest and a deadly complication of cirrhosis that happens in 10% to 30% of patients admitted to hospital. The main mechanism that is being associated with its occurrence are bacterial overgrowth with translocation through the increased permeable small intestinal wall and impaired immune defense. The Gram-negative aerobic bacteria are the major pathogens responsible for SBP episodes although Gram-positive bacteria are being considered emergent agents. The ready diagnosis of SBP is a key factor for the decrease in mortality rates observed in recent years. The medical diagnosis is neither sensitive nor specific and the search for new useful and available tools to make it quicker is an important endpoint of current studies. The use of empirical antibiotics, mainly cefotaxime, improves significantly the short-term prognosis of patients with SBP. The recurrence rate is high and antibiotic prophylaxis has been recommended in high-risk scenarios. Unfortunately, the long-term prognosis remains poor.