UMEM Educational Pearls

Category: Infectious Disease

Title: Spontaneous Bacterial Peritonitis

Keywords: spontaneous bacterial peritonitis, ascites, paracentesis (PubMed Search)

Posted: 10/14/2008 by Mike Winters, MD (Updated: 12/9/2019)
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Can You Rely on Your Clinical Impression to Exclude SBP?

  • SBP is an important can't miss diagnosis, as the mortality rate even for treated patients is approximately 20%
  • The incidence of SBP ranges from 2.5% (clinic setting) to 12% of all patients admitted with decompensated cirrhosis
  • SBP is diagnosed by a neutrophil count > 250 or a positive ascitic fluid culture obtained via paracentesis
  • Can our clinical impression exclude SBP without performing a paracentesis? Unfortunately, the answer is NO.
  • Sensitivity of physician clinical impression is just about 75%, with a specificity of 34%
  • Fever is uncommon in patients with SBP (sensitivity as low as 17%)
  • Take Home Point: only a diagnostic paracentesis can reliably exclude SBP in patients admitted for decompensated cirrhosis

References

Chinnock B, Afarian H, Minnigan H, Butler J, Hendey GW. Ann Emerg Med 2008;52:268-73.