Spontaneous bacterial peritonitis natural history

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2] Ahmed Younes M.B.B.CH [3]

Early diagnosis and initiating treatment is the most important factor for improving the survival and avoiding the complications of SBP. The sooner the diagnosis, the better the outcome.

• SBP is treatable with antibiotics but early diagnosis and intiation of empiric antibiotic therapy is the most important factor for survival.
• In a study performed in 2006, Each hour of delay of administration of empiric antibiotics was associated with increased mortality by 7.6% while administration of antibiotics at the first hour of hypotension increased overall survival to 79%.^[1]

The physician should have a high index of suspicion to diagnose SBP early and start empiric antibiotic therapy. The earlier the stage of diagnosis, the better the survival.

• With the progression of infection, septicaemia ensues with its classic symptoms and signs. Septicaemia and shock are associated with very bad prognosis.

• Hepatic decompensation in association with the progression of infection make altered mental status more likely to happen. Ammonia levels can be within normal limits or slightly elevated as hepatic decompensation is not the only element leading to the altered mental status.

• Peritoneal inflammation can be complicated with paralytic ileus. Paralytic ileus is a very poor prognostic sign with increased mortality rate.

• Diarrhea is common due to associated intestinal bacterial overgrowth.^[2]

• Mortality of SBP remains high. 1-year mortality rate is 30-90% ^[3], probably due to the advanced liver disease present in the first place.
• Early admission and prophylactic cephalosporins might have a role in decreasing mortality rate.^[4]