Scribd Logo
Upload

Welcome to Scribd!

  • 0 - Spontaneous Bacterial Peritonitis

    Uploaded by

    Wi Hardiyanti
    9 views27 pages

    Original Title

    0_Spontaneous Bacterial Peritonitis

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    9 views27 pages

    0 - Spontaneous Bacterial Peritonitis

    Uploaded by

    Wi Hardiyanti

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 27

    The Use of Antibiotic in

    The Treatment of
    Spontaneous Bacterial
    Peritonitis
    INSERProf. Dr. dr. Gontar Alamsyah Siregar, SpPD, K-GEH, FINASIM
    Division of Gastroentero-Hepatology, Department of Internal Medicine,
    Universitas Sumatera Utara/ H. Adam Malik General Hospital
    T THE TITLE
    OF YOUR PRESENTATION HERE
    Outline

    Definition & Epidemiology

    Pathophysiology

    Classification

    Bacteriology

    Diagnosis

    Treatment

    Prophylaxis
    Definition & Epidemiology

    – Spontaneous bacterial peritonitis (SBP)  an infection of ascitic fluid without


    a definitive intra-abdominal source that can be surgically treated, a common
    complication in patients with cirrhosis and ascites
    – The incidence of SBP ranges from 10% to 30%
    – Mortality from 10% to 46% in hospitalised patients.
    Pathophysiology
    Classification of SBP

    Aliment Pharmacol Ther 2015; 41: 1116-1131


    Distinguishing Secondary Peritonitis from SBP

     PMN count > 250 cells/mm3 with > 2 of the following ascitic fluid findings
    provides strong evidence of secondary bacterial peritonitis:
    – Total protein concentration > 1 g/dL
    – Glucose concentration <50 mg/dL
    – LDH greater than the upper limit of normal for serum
     Polymicrobial ascites fluid culture
     Mortality is 100% if no surgical intervention
    Clinical Setting of SBP

    Aliment Pharmacol Ther 2015; 41: 1116-1131


    Bacteriology
     Gram negative bacilli
    (GNB) are the major cause
    of SBP.
     E.coli was found in the
    majority of patients with
    SBP as reported by Conn
    et al.(66%) and Kerr et al.
    (72%)

    Source : Yakar 2010. Piroth 2009, Ariza 2012, Kim 2010, Kamani 2008,
    Cheong 2009, Cholongitas 2005, Novocic 2012, Fernandez 2007.
    Bacteriology

    Source:
    Sebastián,Marciano,Juan Manuel Díaz. Et al, 2019
    Gram negative bacteria were the major pathogen
    involved in SBP in cirrhotic patients. E.coli was the
    major pathogen (24.3%), Klebsiella pneumoniae
    (12%), and Enterococcus faecium (10.5%)

    Nosocomial SBP had a poorer outcome compared


    with community-acquired SBP
    The most common etiology of SBP :

    1. 1997-1998 period : E coli (36.11%)


    2. 2002-2003 period : Staphylococcus
    coagulase-negative (35.55%)
    3. 2014-2015 period : E coli (23,1%)
    Diagnosis

     SBP is not a clinical diagnosis, and it cannot be made without ascitic


    fluid analysis. The diagnosis achieved in the absence of any apparent
    etiology of infection or secondary peritonitis

    Symptoms and signs


     Fever, abdominal pain, vomiting, diarrhea, paralytic ileus, encepha
    lopathy/ altered sensorium
     Hypotension, hyper/hypo-thermia, leukocytosis, acidosis
    Indications for Performing Diagnostic Paracentesis
    Approach to the Diagnosis and
    Treatment of SBP
    Treatment

    Antibiotic
     3rd generation broad spectrum cephalosporins are the agents of choice for SBP treatment.
     Cefotaxime has excellent ascitic fluid penetration and achieves sterilisation in 94% of cases after
    initial antibiotic dosing.
    – Cefotaxime 2 g every 8 h (6 g/day) is considered the standard regimen
     Alternative options include amoxicillin/clavulanic acid and quinolones such as ciprofloxacin or
    ofloxacin
    Switch therapy
     Patients with SBP can be adequately treated with oral antibiotic after a short course of IV antibio
    tic for infection resolution and more cost effective.
    Treatment

     After start IV antibiotics  repeat diagnostic paracentesis after 48 h 


    ascites PMN reduced by at least 25%
     Yes : continue IV antibiotics minimum 5 days
     No : Broad antibiotic spectrum (broader spectrum agents such as C
    efepime, Piperacillin-tazobactam, Carbapenem; addition anaerobic c
    overage agent such as metronidazole), investigate secondary perito
    nitis (should undergo surgical intervention)
    3rd Generations cephalosporins are still an effective
    option for the treatment of CA-SBP
    Third generation cephalosporin seems to provide adequate
    empirical treatment in patients with community acquired
    and healthcare-associated SBP
    Guideline Recommendations for Treatment of SBP
    Therapy for SBP with Special Considerations

    Standard therapy : Complicated community acquired SBP


    Treatment with IV Albumin plus Cefotaxime in Patients with SBP

    Sort P, Navasa M, Arroyo V, et al. N Engl J Med. 2009;341:430-9.


    Indications for SBP Prophylaxis
    Regimens for SBP Prophylaxis
    Regimens for SBP Prophylaxis
    Take Home Message

     SBP is severe infection with high mortality (10%-46%)

     Gram negative bacilli (GNB) are the major cause of SBP (53%).

     Paracentesis is main approach diagnostic tools for SBP within sign of peritonitis and
    infection, hepatic encephalopathy state, new onset of renal failure.

     First line treatment with a third-generation cephalosporin plus Albumin IV can


    reduce mortality of patients with SBP.

     Quinolone (Ciprofloxacin 500mg PO daily) is the 1st regimen for SBP prophylaxis.
    THANK YOU

    You might also like