a Department of Medical Sciences, Ospedali Riuniti di Foggia , Foggia , Italy.
b Department of Radiology, Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy.
Expert Rev Gastroenterol Hepatol. 2019 Aug;13(8):751-759. doi: 10.1080/17474124.2019.1644167. Epub 2019 Jul 18.
: Spontaneous bacterial peritonitis represents a frequent and severe complication in cirrhotic patients with ascites. In daily practice, the diagnosis of spontaneous bacterial peritonitis might be challenging in the absence of the typical signs and symptoms of infection such as fever or leukocytosis. : Aim of this review is to revise the current state of the art on primary and secondary spontaneous bacterial peritonitis. Literature search in Medline/Pubmed was performed. : Historically, gram-negative bacteria were the most frequent etiologic agents of spontaneous bacterial peritonitis, with and spp. being the most frequently isolated bacteria. However, major changes in this regard occurred over the last few decades with an increasing prevalence of gram-positive, quinolone-resistant, and multidrug-resistant bacteria. In particular, the increasing prevalence of quinolone-resistant bacteria challenged the prominent role of norfloxacin in spontaneous bacterial peritonitis prevention. Given the high mortality rate and the risk of developing the hepatorenal syndrome, prophylaxis of spontaneous bacterial peritonitis is indicated in three high-risk populations: patients with acute gastrointestinal hemorrhage, patients with low total protein content in ascitic fluid and advanced cirrhosis, and patients with a previous history of spontaneous bacterial peritonitis (secondary prophylaxis).
自发性细菌性腹膜炎是肝硬化腹水患者的一种常见且严重的并发症。在日常实践中，如果没有感染的典型症状和体征，如发热或白细胞增多，自发性细菌性腹膜炎的诊断可能具有挑战性。本文旨在综述原发性和复发性自发性细菌性腹膜炎的最新研究进展。在 Medline/Pubmed 上进行了文献检索。
在历史上，革兰氏阴性菌是自发性细菌性腹膜炎最常见的病原体， 和 是最常分离到的细菌。然而，在过去几十年中，这方面发生了重大变化，革兰氏阳性、喹诺酮类耐药和多药耐药菌的流行率不断上升。特别是，喹诺酮类耐药菌的流行挑战了诺氟沙星在自发性细菌性腹膜炎预防中的突出地位。鉴于高死亡率和肝肾功能衰竭综合征的风险，自发性细菌性腹膜炎的预防适用于三个高危人群：急性胃肠道出血患者、腹水总蛋白含量低和肝硬化晚期患者以及有自发性细菌性腹膜炎病史的患者（二级预防）。
