Péritonite bactérienne spontanée

Diagnostic

• Ponction d'ascite avec numération de leucocytes neutrophiles à ≥250/μl
• Gradient albumine sérum-ascite

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 mmol/l,
    • serum creatinine level greater than or equal to 106.1 µmol/l,
    • blood urea nitrogen level greater than or equal to 8.9 mmol/l,
    • serum bilirubin level greater than or equal to 51.3 µmol/l,
    • 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
  • Ceftriaxone 2 g 1x/j (ou lévofloxacine) pdt 5 j si ponction d'ascite à 48h stérile et < 250 neutrophiles/μl
  • 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 = prévention primaire du syndrome hépato-rénal.