Péritonite bactérienne spontanée
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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 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),
- Child-Turcotte-Pugh class B or C cirrhosis.
- 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:
- 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.
- Ceftriaxone 2 g 1x/j (ou lévofloxacine) pdt 5 j si ponction d'ascite à 48h stérile et < 250 neutrophiles/μl[1]
Références
- ↑ Guide d’antibiothérapie empirique chez l’adulte CHUV, édition 2019