Spontaneous bacterial peritonitis (SBP) is common in hospitalised patients with cirrhosis and ascites, and often presents without abdominal pain or fever, sometimes only as encephalopathy, kidney injury or general decline.
Perform a diagnostic paracentesis in every patient with cirrhosis and ascites who is admitted, and in any who deteriorate in hospital. An ascitic neutrophil count of 250 cells/mm³ or more confirms SBP. Inoculate culture bottles at the bedside to improve yield.
Treat promptly with an appropriate antibiotic, and give intravenous albumin on day 1 and day 3 to patients with raised creatinine, urea or bilirubin, which reduces kidney failure and death. Coagulopathy is not a contraindication to a diagnostic tap.
- Tap ascites in every admitted patient with cirrhosis, symptomatic or not
- Diagnose SBP at an ascitic neutrophil count of 250/mm³ or more
- Inoculate blood culture bottles with ascitic fluid at the bedside
- Give albumin on days 1 and 3 in SBP with renal or liver dysfunction
Why it matters
Delayed diagnosis of SBP raises mortality, and the symptoms are often absent.
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