Spontaneous bacterial peritonitis: recent guidelines and beyond.

INTRODUCTION Spontaneous bacterial peritonitis (SBP) is the most frequent and life-threatening infection in patients with liver cirrhosis requiring prompt recognition and treatment. It is defined by the presence of >250 polymorphonuclear cells (PMN)/mm in ascites in the absence of an intra-abdominal source of infection or malignancy. In this review we discuss the current opinions reflected by recent guidelines (American Association for the Study of Liver Diseases, European Association for the Study of the Liver, Deutsche Gesellschaft für Verdauungsund Stoffwechselkrankheiten), with particular focus on controversial issues as well as open questions that need to be addressed in the future. First, diagnostic criteria and tools available for rapid and accurate diagnosis are reviewed. Second, since prophylaxis is of crucial relevance when trying to improve survival, we discuss who should be treated, when, how and for how long to prevent episodes of SBP. Identification of risk factors and individualisation of timing and selection of prophylactic measures are the key to success without major development of resistant bacteria. Finally, effective therapy is essential since treatment failure is associated with poor outcome. Since the emergence and spread of drug-resistant bacteria has accelerated, criteria for the choice of antibiotic regimen in the individual patient are pivotal for optimising therapy.