How is spontaneous bacterial peritonitis (SBP) diagnosed following paracentesis?

Updated: Jul 05, 2018
  • Author: Gil Z Shlamovitz, MD, FACEP; Chief Editor: Vikram Kate, MBBS, MS, PhD, FRCS, FACS, FACG, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS  more...
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An ascitic fluid polymorphonuclear leukocyte (PMN) count higher than 250/μL (neutrocytic ascites), with the percentage of PMNs in the fluid usually greater than 50%, is presumptive evidence of SBP. Patients whose ascitic fluid meets these criteria should be treated empirically, regardless of symptoms. Secondary bacterial peritonitis is defined as infected ascitic fluid associated with an intra-abdominal infection.

A report by Lutz et al demonstrated that the relative PMN count, as compared with the absolute PMN count, is a less expensive marker associated with bacterascites and can be used to predict future episodes of SBP. [8]  This may be sueful for the purpsoes of risk stratification.

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