Péritonite bactérienne spontanée

Diagnostic

• Ponction d'ascite avec numération de leucocytes neutrophiles à ≥250/μl

Prophylaxie

• Si saignement de varices oesophagiennes
  • Ceftriaxone/ciprofloxacine durant 7 jours
  • Permet d'éviter les complications d'une translocation bactérienne
• Si patient ascitique à haut risque de PBS
  • Criteria for patients at high risk include an ascitic-fluid total protein level less than 1.5 g/dL (15 g/L) in conjunction with any of the following: serum sodium level less than or equal to 130 mEq/L (130 mmol/L), serum creatinine level greater than or equal to 1.2 mg/dL (106.1 µmol/L), blood urea nitrogen level greater than or equal to 25 mg/dL (8.9 mmol/L), serum bilirubin level greater than or equal to 3 mg/dL (51.3 µmol/L), or Child-Turcotte-Pugh class B or C cirrhosis.
• Si antécédent de PBS
  • Patients who have had a bout of SBP should also receive lifelong antibiotic prophylaxis to reduce the risk for recurrence
• Pas de bénéfice démontré de la perfusion d'albumine en prévention primaire

Traitement

• Si critères de PBS présents
  • If patients have kidney dysfunction, or significant hepatic dysfunction as measured by a serum bilirubin level greater than 4 mg/dL (68 µmol/L), adjunctive therapy with albumin (1.5 g/kg body weight on day 1, as well as 1 g/kg on day 3) should be administered; such treatment has a demonstrated survival benefit.