Velkey Bálint, Vitális Eszter, Vitális Zsuzsanna
Belgyógyászati Intézet, Gasztroenterológia Nem Önálló Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4032.
Aneszteziológiai és Intenzív Terápiás Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen.
Orv Hetil. 2017 Jan;158(2):50-57. doi: 10.1556/650.2017.30637.
Spontaneous bacterial peritonitis occurs most commonly in cirrhotic patients with ascites. Pathogens get into the circulation by intestinal translocation and colonize in peritoneal fluid. Diagnosis of spontaneous bacterial peritonitis is based on elevated polymorphonuclear leukocyte count in the ascites (>0,25 G/L). Ascites culture is often negative but aids to get information about antibiotic sensitivity in positive cases. Treatment in stable patient can be intravenous then orally administrated ciprofloxacin or amoxicillin/clavulanic acid, while in severe cases intravenous III. generation cephalosporin. Nosocomial spontaneous bacterial peritonitis often caused by Gram-positive bacteria and multi-resistant pathogens can also be expected thus carbapenem should be the choice of the empiric treatment. Antibiotic prophylaxis should be considered. Norfloxacin is used most commonly, but changes are expected due to increase in quinolone resistance. As a primary prophylaxis, a short-term antibiotic treatment is recommended after gastrointestinal bleeding for 5 days, while long-term prophylaxis is for patients with low ascites protein, and advanced disease (400 mg/day). Secondary prophylaxis is recommended for all patients recovered from spontaneous bacterial peritonitis. Due to increasing antibiotic use of antibiotics prophylaxis is debated to some degree. Orv. Hetil., 2017, 158(2), 50-57.
自发性细菌性腹膜炎最常发生于肝硬化腹水患者。病原体通过肠道细菌移位进入血液循环，并在腹腔积液中定植。自发性细菌性腹膜炎的诊断基于腹水多形核白细胞计数升高（>0.25×10⁹/L）。腹水培养常为阴性，但在阳性病例中有助于了解抗生素敏感性。病情稳定的患者治疗可先静脉给药，然后口服环丙沙星或阿莫西林/克拉维酸，而重症患者则静脉使用第三代头孢菌素。医院获得性自发性细菌性腹膜炎常由革兰氏阳性菌和多重耐药病原体引起，因此碳青霉烯类应作为经验性治疗的选择。应考虑抗生素预防。最常用的是诺氟沙星，但由于喹诺酮耐药性增加，情况可能会有所变化。作为一级预防，胃肠道出血后建议短期使用抗生素治疗5天，而长期预防适用于腹水蛋白低和病情晚期的患者（400毫克/天）。建议对所有自发性细菌性腹膜炎康复患者进行二级预防。由于抗生素使用增加，抗生素预防在一定程度上存在争议。《匈牙利医学周报》，2017年，158(2)，50 - 57。
