Downloaded from gut.bmj.com on May 31, 2012 - Published by group.bmj.com Recent advances in clinical practice Spontaneous bacterial peritonitis: recent guidelines and beyond R Wiest,1 A Krag,2 A Gerbes3 1Department for visceral surgery INTRODUCTION prognosis in various cohorts of patients with SBP and medicine, University Spontaneous bacterial peritonitis (SBP) is the most are summarised in figure 1 and include age,16 20 Hospital Bern, Switzerland 18 20 23 16 18 2 frequent and life-threatening infection in patients Child score, intensive care, nosocomial Department of 18 24 25 Gastroenterology, Hvidovre with liver cirrhosis requiring prompt recognition origin, hepatic encephalopathy, elevated 26 University Hospital, and treatment. It is defined by the presence of >250 serum creatinine and bilirubin, lack of infection Copenhagen, Denmark polymorphonuclear cells (PMN)/mm3 in ascites in resolution/need to escalate treatment and culture 3 e Klinikum of the University of the absence of an intra-abdominal source of infec- positivity27 29 as well as the presence of bacter- Munich, Munich, Germany tion or malignancy. In this review we discuss the aemia30 and CARD15/NOD2 variants as a genetic fl 31 Correspondence to current opinions re ected by recent guidelines risk factor. It is important to stress in this context Professor Dr Reiner Wiest, (American Association for the Study of Liver that the only factors that are modifiable in this Department for visceral surgery Diseases, European Association for the Study of the scenario are timely diagnosis and effective first-line and medicine, University Liver, Deutsche Gesellschaft für Verdauungs- und treatment. Hospital Bern, 3010 Bern, 1e4 Switzerland; Stoffwechselkrankheiten), with particular focus
[email protected] on controversial issues as well as open questions Bacterial translocation (BT) and pathophysiology that need to be addressed in the future.