Guidelines
Diagnostics

Diagnostics

Presentation

Cirrhosis, ascites, fever, and abdominal tenderness

Can be subtle compared to secondary peritonitis

Diagnostics

Paracentesis before starting antibiotics is ideal

  • Diagnostic if PMN (neutrophil) absolute count ≥ 250 cells/μL
  • If PMN < 250 cells/μL, but clinical pictures is highly suggestive of SBP continue empiric therapy until a negative culture result
  • Bacterial culture

  • Can consider fungal and mycobacterial

  • Inoculate a minimum of 2 blood culture bottles (1 aerobic & 1 anaerobic) with 10 mL of the ascitic fluid

  • Can identify an organism

Secondary bacterial peritonitis should be ruled out either clinically, radiographically or by ascitic fluid analysis before the diagnosis of SBP is made