title: Review article: spontaneous bacterial peritonitis--bacteriology, diagnosis, treatment, risk factors and prevention.
abstract: BACKGROUND
  Spontaneous bacterial peritonitis (SBP) is a severe and often fatal infection in patients with cirrhosis and ascites.
  
  
  OBJECTIVE
  To review the known and changing bacteriology, risk factors, ascitic fluid interpretation, steps in performing paracentesis, treatment, prophylaxis and evolving perspectives related to SBP.
  
  
  METHODS
  Information was obtained from reviewing medical literature accessible on PubMed Central. The search term 'spontaneous bacterial peritonitis' was cross-referenced with 'bacteria', 'risk factors', 'ascites', 'paracentesis', 'ascitic fluid analysis', 'diagnosis', 'treatment', 'antibiotics', 'prophylaxis', 'liver transplantation' and 'nutrition'.
  
  
  RESULTS
  Gram-positive cocci (GPC) such as Staphylococcus, Enterococcus as well as multi-resistant bacteria have become common pathogens and have changed the conventional approach to treatment of SBP. Health care-associated and nosocomial SBP infections should prompt greater vigilance and consideration for alternative antibiotic coverage. Acid suppressive and beta-adrenergic antagonist therapies are strongly associated with SBP in at-risk individuals.
  
  
  CONCLUSIONS
  Third-generation, broad-spectrum cephalosporins remain a good initial choice for SBP treatment. Levofloxacin is an acceptable alternative for patients not receiving long-term flouroquinolone prophylaxis or for those with a penicillin allergy. For uncomplicated SBP, early oral switch therapy is reasonable. Alternative antibiotics such as pipercillin-tazobactam should be considered for patients with nosocomial SBP or for patients who fail to improve on traditional antibiotic regimens. Selective albumin supplementation remains an important adjunct in SBP treatment. Withholding acid suppressive medication deserves strong consideration, and discontinuing beta-adrenergic antagonist therapy in patients with end-stage liver disease and resistant ascites is standard care. Liver transplant evaluation should be undertaken for patients who develop SBP barring contraindications.
authors.affiliation: Department of Gastroenterology, VA San Diego Healthcare System, San Diego, CA, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Dever
authors.forename: M Y
authors.initials: MY
authors.lastname: Sheikh
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001201:Ascites / Q000150:complications; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D003428:Cross Infection; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D016031:Liver Transplantation; D019152:Paracentesis / Q000379:methods; D010538:Peritonitis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents