Spontaneous Bacterial Peritonitis in Hepatic Cirrhosis Patients: Literature Review

Abstract

Bacterial infection is a complication of liver cirrhosis which accounts for 30% of deaths in the first month and 63% after the first year. The most common bacterial infection in liver cirrhosis is spontaneous bacterial peritonitis. The diagnosis is made when the polymorphonuclear ascitic leukocyte count (PMN) is >250 cells/mm³ with or without positive culture or positive ascitic culture with PMN < 250 cells/mm³. One of the markers of spontaneous bacterial peritonitis is serum procalcitonin. Procalcitonin as an acute phase reactant protein has been studied in patients with PBS. Serum procalcitonin in patients with spontaneous bacterial peritonitis was higher than in patients with uninfected ascites. Significantly higher in patients with PBS than in sterile ascites. Calcitonin is associated with an increased number of PMNs in cirrhotic liver patients with spontaneous bacterial peritonitis. Management of spontaneous bacterial peritonitis in patients with liver cirrhosis considers the speed and accuracy of diagnosis and stratification of patients who are candidates for albumin recipients. Empirical antibiotic therapy should be initiated as soon as the diagnosis of spontaneous bacterial peritonitis is made to reduce the development of complications and improve survival. First-line antibiotics are third-generation cephalosporins (cefotaxime or ceftriaxone) or piperacillintazobactam. Ceftolozane-tazobactam and ceftazidimeavibactam have been developed for carbapenem-resistant patients.