Spontaneous bacterial peritonitis classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Shivani Chaparala M.B.B.S [3] Ahmed Younes M.B.B.CH [4]
Overview
Spontaneous bacterial peritonitis is one variant of ascitic fluid infections.[1] Classification of ascitic fluid infections is based on neutrophil count and culture report.[2][3] Asymptomatic bacterascites is usually the transient residence of bacteria in ascitic fluid without clinical features of peritonitis or increased ascitic fluid polymorphonuclear cells.[4] SBP is also classified based on the routes of infection and the clinical setting as follows health care-associated, nosocomial, community acquired, multi-drug resistant and recurrent.
Classification
- Spontaneous bacterial peritonitis is one of the variants of ascitic fluid infections.[1]
- Classification of ascitic fluid infections is based on neutrophil count and culture report.[2][3]
- Asymptomatic bacterascites is usually the transient residence of bacteria in ascitic fluid without clinical features of peritonitis or increased ascitic fluid polymorphonuclear cells.[4]
| Type of Infection | Bacterial Culture Report | Ascitic fluid analysis Neutrophil Count (cells/mm3) | Clinical aspects | |
|---|---|---|---|---|
| Spontaneous bacterial peritonitis[5] | Positive usually for one organism | ≥250 | Patients with cirrhosis and ascites in the presence or absence of symptoms and signs | |
| Culture negative neutrocytic ascites (CNNA)[6][7] | Negative | ≥250 | Poor culture technique and prior antibiotics or low opsonic activity in ascitic fluid. Commonly encountered phenotype and requires antibiotic therapy. | |
| Monomicrobial bacterascites[8] | Positive for one organism | <250 | Ascitic fluid infection which may resolve spontaneously or progress to SBP. Mortality is similar to SBP and should be treated as SBP. | |
| Secondary bacterial peritonitis | Positive for many microbes | ≥250 | Intraperitoneal source of infection e.g. diverticulitis | |
| Polymicrobial bacterascites[9] | Positive for many microbes | <250 | Usually due to bowel perforation by the paracentesis needle and reflects growth of gut flora before the ascitic fluid can mount a neutrocytic response. |
Classification Based on Clinical Setting
Based on the route of infection SBP is classified as follows:[2][10]
| Clinical setting associated with SBP | Criteria |
|---|---|
| Health care-associated SBP (HCA) |
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| Nosocomial SBP |
|
| Community acquired SBP (CA) |
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| Multi-drug resistant SBP |
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| Recurrent SBP |
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References
- ↑ 1.0 1.1 Sheer TA, Runyon BA (2005). "Spontaneous bacterial peritonitis". Dig Dis. 23 (1): 39–46. doi:10.1159/000084724. PMID 15920324.
- ↑ 2.0 2.1 2.2 Dever JB, Sheikh MY (2015) Review article: spontaneous bacterial peritonitis--bacteriology, diagnosis, treatment, risk factors and prevention. Aliment Pharmacol Ther 41 (11):1116-31. DOI:10.1111/apt.13172 PMID: 25819304
- ↑ 3.0 3.1 Runyon BA, AASLD Practice Guidelines Committee (2009). "Management of adult patients with ascites due to cirrhosis: an update". Hepatology. 49 (6): 2087–107. doi:10.1002/hep.22853. PMID 19475696.
- ↑ 4.0 4.1 Pelletier G, Lesur G, Ink O, Hagege H, Attali P, Buffet C; et al. (1991). "Asymptomatic bacterascites: is it spontaneous bacterial peritonitis?". Hepatology. 14 (1): 112–5. PMID 2066060.
- ↑ Kim SU, Kim DY, Lee CK, Park JY, Kim SH, Kim HM; et al. (2010). "Ascitic fluid infection in patients with [[hepatitis B]] virus-related liver [[cirrhosis]]: culture-negative neutrocytic ascites versus spontaneous bacterial [[peritonitis]]". J Gastroenterol Hepatol. 25 (1): 122–8. doi:10.1111/j.1440-1746.2009.05970.x. PMID 19845823. URL–wikilink conflict (help)
- ↑ Pelletier G, Salmon D, Ink O, Hannoun S, Attali P, Buffet C; et al. (1990). "Culture-negative neutrocytic ascites: a less severe variant of spontaneous bacterial peritonitis". J Hepatol. 10 (3): 327–31. PMID 2365982.
- ↑ Runyon BA, Hoefs JC (1984). "Culture-negative neutrocytic ascites: a variant of spontaneous bacterial peritonitis". Hepatology. 4 (6): 1209–11. PMID 6500513.
- ↑ Runyon BA (1990). "Monomicrobial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis". Hepatology. 12 (4 Pt 1): 710–5. PMID 2210672.
- ↑ Runyon BA, Hoefs JC, Canawati HN (1986). "Polymicrobial bacterascites. A unique entity in the spectrum of infected ascitic fluid". Arch Intern Med. 146 (11): 2173–5. PMID 3778046.
- ↑ Fernández, J (2002). "Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis". Hepatology. 35 (1): 140–148. doi:10.1053/jhep.2002.30082. ISSN 0270-9139.