Stadhouders P H G M, Kuiper J J, van Buuren H R, de Man R A
St. Antonius Ziekenhuis, afd. Maag-, Darm- en Leverziekten, Nieuwegein.
Ned Tijdschr Geneeskd. 2007 Mar 3;151(9):509-13.
Three patients with hepatic cirrhosis and ascites, a 65-year-old man, a 17-year-old woman and a 49-year-old man, were admitted to hospital for progressive drowsiness, increased ascites, and melaena, respectively. An elevated number of polymorphonuclear leukocytes was found in the ascites. The three patients became more and more seriously ill. On the basis of the laboratory findings, a diagnosis of 'spontaneous bacterial peritonitis' was made. The patients recovered after administration of antibiotics. The signs and symptoms of spontaneous bacterial peritonitis can range from subtle, renal dysfunction or an altered mental state to the signs ofan acute abdomen. The common signs of infection such as fever and an elevated leukocyte count are present in only 50% of the patients. Gram-negative bacteria are most frequently isolated from cultures of the ascites fluid. The 1-year mortality is still 50-70% and is partly a result of the underlying liver disease. Prophylactic oral administration of a quinolone decreases the risk of spontaneous bacterial peritonitis in patients with gastrointestinal haemorrhage and in patients with a prior episode of spontaneous bacterial peritonitis. Long-term prophylaxis has been associated with the development of infections with quinolone-resistant microorganisms.
三名肝硬化腹水患者，分别为一名65岁男性、一名17岁女性和一名49岁男性，因逐渐加重的嗜睡、腹水增多和黑便入院。腹水中发现多形核白细胞数量增多。这三名患者病情越来越严重。根据实验室检查结果，诊断为“自发性细菌性腹膜炎”。患者在使用抗生素后康复。自发性细菌性腹膜炎的体征和症状范围广泛，从轻微的肾功能障碍或精神状态改变到急腹症的体征。仅50%的患者出现发热和白细胞计数升高等常见感染体征。革兰氏阴性菌最常从腹水培养物中分离出来。1年死亡率仍为50%-70%，部分原因是潜在的肝脏疾病。预防性口服喹诺酮类药物可降低胃肠道出血患者和既往有自发性细菌性腹膜炎发作患者发生自发性细菌性腹膜炎的风险。长期预防与喹诺酮耐药微生物感染的发生有关。
