Acharya Subrat Kumar
Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Science, New Delhi, India.
Trop Gastroenterol. 2013 Jan-Mar;34(1):7-13. doi: 10.7869/tg.2012.84.
Spontaneous bacterial peritonitis (SBP) is the most frequent infection in patients with cirrhosis. It is associated with high mortality at admission and its occurrence alters the natural course with a high 1 year mortality. Presence of > 250 polymorphonuclear cell (PMN)/mm3 in the India ascitic fluid is diagnostic of SBP. SBP is usually treated with IV antibiotics using third generation cephalosporins and fluoroquinolones. However, despite effective initial treatment subsequent recurrence of SBP with its accompanying mortality has resulted in use of long term antibiotic prophylaxis and such patients are recommended for liver transplant. An increased frequency of multidrug resistant bacterial SBP has recently been recognised with use of prophylaxis and is associated with enhanced mortality. Further, cirrhotics get repeated hospitalisation and ICU care leading to nosocomial infection causing SBP. Therefore, frequency of multidrug resistant bacteria induced SBP among the above settings has increased and the relative risk (RR) of mortality with bacterial resistance has been estimated to be 4 times higher than in patients with SBP without bacterial resistance. Therapeutic approach in such patients at present is a clinical challenge and they are difficult to treat patients. Therefore, SBP can be categorized into community acquired and nosocomial! multidrug resistant SBP.
自发性细菌性腹膜炎（SBP）是肝硬化患者最常见的感染。它与入院时的高死亡率相关，其发生改变了自然病程，1年死亡率很高。印度腹水多形核细胞（PMN）>250/mm³可诊断为SBP。SBP通常采用第三代头孢菌素和氟喹诺酮类静脉注射抗生素治疗。然而，尽管初始治疗有效，但SBP随后复发及其伴随的死亡率导致了长期抗生素预防的使用，此类患者建议进行肝移植。最近认识到，随着预防措施的使用，多重耐药细菌性SBP的发生率增加，且与死亡率升高相关。此外，肝硬化患者反复住院和入住重症监护病房导致医院感染，进而引发SBP。因此，上述情况下多重耐药菌引起的SBP发生率增加，细菌耐药导致的死亡相对风险（RR）估计比无细菌耐药的SBP患者高4倍。目前，对此类患者的治疗方法是一项临床挑战，他们是难治性患者。因此，SBP可分为社区获得性和医院获得性！多重耐药SBP。
