Department of Internal Medicine, Policlinico IRCCS San Donato, Università di Milano, Via Morandi, 30, 20097, San Donato Milanese, Italy.
Intern Emerg Med. 2010 Oct;5 Suppl 1:S45-51. doi: 10.1007/s11739-010-0447-9.
Spontaneous bacterial peritonitis (SBP) is one of the most serious complications occurring in cirrhotic patients with ascites. Therefore, an effective therapy is always required starting immediately after diagnosis. There are three aims of therapy: (1) to eradicate the bacterial strain responsible of the infection; (2) to prevent renal failure; and (3) to prevent SBP recurrence. The first end point is achievable by means of a large-spectrum antibiotic therapy. Empirical antibiotic therapy can be started with a third-generation cephalosporin, amoxicillin-clavulanate or a quinolone. The effectiveness of antibiotics should be verified by determining the percent reduction of polymorphonuclear cells count in the ascitic fluid. If bacteria result to be resistant to the empirical therapy, a further antibiotic must be given according to the in vitro bacterial susceptibility. In most cases, a 5-day antibiotic therapy is enough to eradicate the bacterial strain. Severe renal failure occurs in about 30% of patients with SBP, independently of the response to antibiotics, and it is associated with elevated mortality. The early administration of large amount of human albumin showed to be able to reduce the episodes of renal failure and to improve survival. After the resolution of an episode of SBP, the recurrence is frequent. Therefore, an intestinal decontamination with oral norfloxacin has been shown to significantly reduce this risk and is widely practised. However, such a long-term prophylaxis, as well as the current increased use of invasive procedures, favours the increase of bacterial infections, including SBP, contracted during the hospitalization (nosocomial infections) and sustained by multi-resistant bacteria. This involves the necessity to use a different strategy of antibiotic prophylaxis as well as a more strict surveillance of patients at risk.
自发性细菌性腹膜炎 (SBP) 是肝硬化腹水患者最严重的并发症之一。因此，一旦确诊，就需要立即进行有效的治疗。治疗有三个目的：(1) 消除引起感染的细菌菌株；(2) 预防肾功能衰竭；(3) 预防 SBP 复发。第一个终点可以通过广谱抗生素治疗来实现。经验性抗生素治疗可以使用第三代头孢菌素、阿莫西林克拉维酸或喹诺酮类药物开始。抗生素的有效性可以通过确定腹水中性粒细胞计数的百分比降低来验证。如果细菌对经验性治疗产生耐药性，则根据体外细菌敏感性进一步给予抗生素。在大多数情况下，5 天的抗生素治疗足以消除细菌菌株。约 30%的 SBP 患者会出现严重的肾功能衰竭，与抗生素的反应无关，且与死亡率升高相关。早期给予大量人血白蛋白已被证明能够减少肾功能衰竭的发作并提高生存率。SBP 发作缓解后，复发频繁。因此，口服诺氟沙星进行肠道去污已被证明可以显著降低这种风险，并得到广泛应用。然而，这种长期的预防措施，以及目前侵袭性操作的增加，导致了包括 SBP 在内的细菌感染的增加，这些感染是在住院期间（医院获得性感染）和耐多药细菌引起的。这就需要采用不同的抗生素预防策略，并对高危患者进行更严格的监测。
