Diagnosis of spontaneous and secondary bacterial peritonitis in patients with hepatic cirrhosis and ascites.

Spontaneous bacterial peritonitis (SBP) is an infection that is not caused by intra-abdominal source requiring surgery. Nowadays SBP is the main cause of death in patients with cirrhosis. Treatment is carried out with third generation cephalosporins and albumin infusions. The aim of the study is to identify patients with SBP and to be distinguished from the cases with secondary bacterial peritonitis (SecBP) in patients with cirrhosis and ascites. We studied 167 patients with cirrhosis and ascites and SBP was observed in 25 of them, while SecBP--in 22. The diagnosis of SBP is set in neutrophilic leukocytes in ascites > or = 250 cells/mm3 as bacterial cultures are positive in only 16% of them. Completely asymptomatic course had 16% of patients with SBP. Diagnosis of SecBP (according to Runyon's criteria) is based on increased total protein in ascitic fluid > 10 g/l (in 63.7% of patients > 30 g/l), elevated lactate dehydrogenase in ascites (LDH is > 240 U/l in all patients) and glucose < 2,7 mmol/l (only 4.5% of cases with secondary bacterial peritonitis). In support of SecBP are the polymicrobial flora, the isolation of anaerobes, enterococci, fungi, and the very high number of neutrophilic leukocytes in the peritoneal effusion and the refractoriness from conservative treatment. The examination of ascites with Multistix is more informative in secondary than in spontaneous bacterial peritonitis. In suspected secondary bacterial peritonitis CT is indicated.