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Spontaneous Bacterial Peritonitis

Spontaneous bacterial peritonitis is an infection of fluid that accumulates in the abdomen.

Spontaneous bacterial peritonitis is an infection of abdominal fluid,

Spontaneous bacterial peritonitis is an infection of fluid
called ascites, that does not come from an obvious place within the that accumulates in the abdomen (ascites) and is commonly
abdomen, such as a hole in the intestines or a collection of pus. The associated with advanced liver disease.
condition typically affects people with liver disease, who often de- Liver
(diseased) Peritoneum (lining of the abdomen)
velop ascites as their disease worsens.
Ascitic fluid
Inflammation of the intestines may also
Causes and Symptoms occur. Inflamed intestines can allow
Ascites forms in advanced liver disease when pressure is increased Intestines bacteria to leak into the abdomen.
(inflamed)
across the liver (portal hypertension) and when liver function is im-
paired, which causes levels of certain proteins to be lower in the Testing process
blood. Spontaneous bacterial peritonitis can occur when bacteria that 1 A syringe is used to take a sample
normally live in the intestine enter the abdominal cavity and the as- of the ascitic fluid in a procedure
called paracentesis.
cites becomes infected. This happens in advanced liver disease be-
cause the immune system response weakens and the bacterial en-
vironment in the gut changes. Inflammation can cause the intestines
to become leaky and allow gut bacteria to infect areas of the body
2 The fluid is analyzed for the presence
that are normally germ free. of neutrophils, a type of white blood
The most common symptoms in people with spontaneous bac- cell that accumulates due to infection.

terial peritonitis are fever, chills, and abdominal pain. Some people
may also experience confusion. However, there can also be no symp-
toms. Individuals who have advanced liver disease with ascites and
are hospitalized for confusion and/or liver or kidney malfunction
should be tested for spontaneous bacterial peritonitis.
Testing, Treatment, and Prevention
The biggest risk with spontaneous bacterial peritonitis is sepsis, the
rapid progression of infection to the whole body. It is important to
recognize spontaneous bacterial peritonitis quickly so it can
be treated. Doctors test for it by using a small needle and syringe to
take a sample of the ascitic fluid to measure the number of white
blood cells.
Spontaneous bacterial peritonitis can be treated with
intravenous (IV) antibiotics. A few days after starting antibiotics, a
doctor may take another fluid sample to make sure the treatment
is working.
People who have had spontaneous bacterial peritonitis are at
risk of developing it again. Doctors may prescribe daily oral antibi-
otics to people who have either had spontaneous bacterial perito-
nitis or who are at risk of developing it because they have very low
protein levels in their ascitic fluid. Patients with advanced liver dis-
ease and ascites who experience bleeding from the esophagus, stom-
Prompt diagnosis and treatment
are important to prevent rapid
progression of infection.
Treatment may include:
• Intravenous antibiotics • Water pills (diuretics)
• Intravenous albumin • High-protein diet
• Lowering of salt intake
FOR MORE INFORMATION
Spontaneous bacterial peritonitis (US National Library of
Medicine)
https://medlineplus.gov/ency/article/000648.htm
To find this and other JAMA Patient Pages, go to the Patient
Information collection at jamanetworkpatientpages.com.
ach, or intestines should receive antibiotics for 5 to 7 days to pre-
vent spontaneous bacterial peritonitis.
Ascites can be treated by lowering salt intake and/or using wa-
ter pills (diuretics). People with advanced liver disease should also
try to eat a high-protein diet to maintain good nutrition. Regular ex-
ercise is also encouraged to prevent loss of muscle.

Authors: Grace Zhang, BS; Alison Jazwinski Faust, MD
Author Affiliations: University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania (Zhang); Penn State Hershey Medical Center, Hershey, Pennsylvania
(Jazwinski Faust).
Conflict of Interest Disclosures: None reported.
Source: Wong CL, Holroyd-Leduc J, Thorpe KE, Straus SE. Does this patient have
bacterial peritonitis or portal hypertension? JAMA. 2008;299(10):1166-1178.
doi:10.1001/jama.299.10.1166
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