Spontaneous Bacterial Peritonitis | Infectious Diseases | JAMA | JAMA Network
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JAMA Patient Page
March 16, 2021

Spontaneous Bacterial Peritonitis

Author Affiliations
  • 1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 2Penn State Hershey Medical Center, Hershey, Pennsylvania
JAMA. 2021;325(11):1118. doi:10.1001/jama.2020.10292

Spontaneous bacterial peritonitis is an infection of fluid that accumulates in the abdomen.

Spontaneous bacterial peritonitis is an infection of abdominal fluid, called ascites, that does not come from an obvious place within the abdomen, such as a hole in the intestines or a collection of pus. The condition typically affects people with liver disease, who often develop ascites as their disease worsens.

Causes and Symptoms

Ascites forms in advanced liver disease when pressure is increased across the liver (portal hypertension) and when liver function is impaired, which causes levels of certain proteins to be lower in the blood. Spontaneous bacterial peritonitis can occur when bacteria that normally live in the intestine enter the abdominal cavity and the ascites becomes infected. This happens in advanced liver disease because the immune system response weakens and the bacterial environment in the gut changes. Inflammation can cause the intestines to become leaky and allow gut bacteria to infect areas of the body that are normally germ free.

The most common symptoms in people with spontaneous bacterial peritonitis are fever, chills, and abdominal pain. Some people may also experience confusion. However, there can also be no symptoms. Individuals who have advanced liver disease with ascites and are hospitalized for confusion and/or liver or kidney malfunction should be tested for spontaneous bacterial peritonitis.

Testing, Treatment, and Prevention

The biggest risk with spontaneous bacterial peritonitis is sepsis, the rapid progression of infection to the whole body. It is important to recognize spontaneous bacterial peritonitis quickly so it can be treated. Doctors test for it by using a small needle and syringe to take a sample of the ascitic fluid to measure the number of white blood cells.

Spontaneous bacterial peritonitis can be treated with intravenous (IV) antibiotics. A few days after starting antibiotics, a doctor may take another fluid sample to make sure the treatment is working.

People who have had spontaneous bacterial peritonitis are at risk of developing it again. Doctors may prescribe daily oral antibiotics to people who have either had spontaneous bacterial peritonitis or who are at risk of developing it because they have very low protein levels in their ascitic fluid. Patients with advanced liver disease and ascites who experience bleeding from the esophagus, stomach, or intestines should receive antibiotics for 5 to 7 days to prevent spontaneous bacterial peritonitis.

Ascites can be treated by lowering salt intake and/or using water pills (diuretics). People with advanced liver disease should also try to eat a high-protein diet to maintain good nutrition. Regular exercise is also encouraged to prevent loss of muscle.

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Conflict of Interest Disclosures: None reported.

Source: Wong CL, Holroyd-Leduc J, Thorpe KE, Straus SE. Does this patient have bacterial peritonitis or portal hypertension? JAMA. 2008;299(10):1166-1178. doi:10.1001/jama.299.10.1166