title: [Spontaneous and secondary bacterial peritonitis in cirrhotic patients with ascites].
abstract: Peritonitis is one of the most frequent infectious complications in patients with liver cirrhosis and ascites. In more than 95 % it occurs as spontaneous bacterial peritonitis (SBP) as a result of bacterial translocation from intestinal bacteria and bacterial products into mesenteric lymph nodes and subsequent systemic circulation. Identified risk factors that justify antibiotic prophylaxis for SBP include a prior episode of SBP, gastrointestinal haemorrhage and low ascitic fluid protein in combination with renal or advanced liver failure. SBP requires conservative therapy, which should be empirically performed using third-generation cephalosporins and adjunctive albumin therapy under consideration of individual and nosocomial risk factors for antimicrobial resistance. In contrast to SBP, secondary bacterial peritonitis is a rare ( < 5 % of all cases of peritonitis) and more unfavourable disease. It occurs as a result of hollow organ perforation or intra-abdominal inflammatory or ischaemic processes. Analysis of ascitic fluid may help substantiating the suspicion of secondary peritonitis and should entail a meticulous diagnostic work-up including abdominal computed tomography. Because of the high mortality rate (60 - 80 %) of secondary peritonitis antibiotic regimens with anti-anaerobic activity, prompt surgical treatment and interdisciplinary postoperative care are necessary to improve patient outcomes.
authors.affiliation: Klinik für Innere Medizin II des Universitätsklinikums Jena, Abteilung für Gastroenterologie, Hepatologie und Infektiologie, Jena, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Bruns
authors.affiliation: Klinik für Innere Medizin II des Universitätsklinikums Jena, Abteilung für Gastroenterologie, Hepatologie und Infektiologie, Jena, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Stallmach
mesh_terms: D019072:Antibiotic Prophylaxis; D001201:Ascites / Q000150:complications / Q000382:microbiology; D001424:Bacterial Infections / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control; D018988:Bacterial Translocation / Q000187:drug effects; D002511:Cephalosporins / Q000008:administration & dosage; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control; D010538:Peritonitis / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control; D014057:Tomography, X-Ray Computed
chemical_list: D002511:Cephalosporins