Spontaneous Bacterial Peritonitis: Causes, Symptoms, Treatment and Cost

Spontaneous Bacterial Peritonitis (SBP) is a bacterial infection of the fluid in the abdominal cavity that affects individuals with cirrhosis, ascites, malignancies or other types of intra-abdominal injury.

There are two types of SBP: primary and secondary.

• Primary SBP: Primary SBP occurs when the bacteria enter the body through the bloodstream and make their way to the peritoneal cavity. This type of infection is usually caused by a single species of bacteria, most often E. coli or gram-negative bacilli such as Klebsiella pneumoniae and Enterobacter cloacae.
• Secondary SBP: Secondary SBP occurs when bacteria from another source, such as the intestines or urinary tract, enter the peritoneal cavity. This type of infection is often caused by a combination of different bacterial species, including gram-positive cocci such as Staphylococcus aureus, Streptococcus pneumoniae and Enterococcus faecalis.

• The most common cause is when bacteria enter the abdominal cavity, often through the bowel wall and bloodstream.
• This bacterial infection may also be transferred by contact with infected surfaces, consumption of contaminated food and drink, and inhalation of airborne particles carrying infectious bacteria.
• In some cases, SBP can also be caused by a virus or fungal infection in the abdominal cavity.

• Abdominal pain, tenderness, and distension.
• Fever
• Nausea and vomiting
• Fluid accumulation in the abdomen (ascites) due to decreased albumin levels.
• Fatigue or confusion
• Decrease in appetite, weight loss.

• Avoid Alcohol Abuse and Smoking: Excessive alcohol consumption and smoking can cause liver cirrhosis, which can lead to a buildup of fluid in the abdomen, increasing the risk of SBP.
• Avoid Eating Unsafe Foods: Food contaminated with bacteria like E. coli, salmonella, or Campylobacter can increase the risk of infection and SBP.
• Take Antibiotics Regularly: Taking antibiotics regularly can help reduce your risk of contracting a bacterial infection that could spread to the peritoneum and increase your risk of SBP.
• Vaccinate Yourself Regularly: Receiving regular vaccinations for seasonal flu and pneumococcus can help reduce your chances of getting an infection that could lead to SBP.
• Keep Your Abdomen Clean: Keeping your abdomen clean at all times and avoiding contact with potentially infectious sources such as feces or saliva can help prevent the spread of bacteria that could cause SBP.

• Ascitic Fluid Analysis: This involves analyzing the fluid present in the abdomen to identify any presence of bacteria and other cells. Additionally, the test checks for an elevated white blood cell count, a sign of inflammation or infection.
• Bacterial Culture: This test involves culturing a sample of the ascitic fluid to determine which bacteria are causing the infection. This may assist in determining which antibiotics are necessary to treat the infection.
• Ultrasound: An ultrasound uses sound waves to create an image that can detect any abnormalities in the abdominal area such as fluid buildup or enlarged organs that could indicate infection or inflammation.
• Liver Function Tests: These tests measure liver enzymes and other substances in the blood that can indicate liver damage from infection or inflammation.
• Blood Tests: These tests look for signs of infection or inflammation in the body, like a rising number of white blood cells or other markers.
• Chest X-ray: A chest x-ray may help identify any complications from SBP such as lung infections, fluid buildup, or signs of cirrhosis (scarring) in the liver due to long-term inflammation from SBP.

• Septic shock: A life-threatening condition caused by a sudden decrease in blood pressure due to bacterial toxins.
• Endocarditis: An infection of the endocardial tissue which lines the chambers and valves of the heart.
• Abscess formation: The formation of abscesses (pus-filled cavities) as a result of tissue destruction caused by bacterial toxins released into the body.
• Acute renal failure: A potentially fatal condition where kidneys fail to remove water and waste from the bloodstream adequately, resulting in high levels of waste materials accumulating in the body.
• Hepatic encephalopathy: A neurological disorder resulting from high levels of ammonia circulating in the blood, leading to confusion and impaired mental functioning.
• Systemic inflammatory response syndrome (SIRS): An increased release of inflammatory mediators throughout the body, causing fever, changes in heart rate and breathing rate, low or high white blood cell counts, among other severe symptoms.

• Applying a hot compress on the abdomen can help reduce pain and discomfort caused by Spontaneous Bacterial Peritonitis.
• Drinking of warm lemon water with a teaspoon of honey can help reduce inflammation and symptoms associated with this condition.
• Boiling fenugreek seeds in water and drinking it can be effective in treating infections caused by Spontaneous Bacterial Peritonitis.
• Taking fresh or dried ginger can reduce nausea, vomiting, and other digestive issues that are associated with this condition.
• Consuming coriander seed powder mixed in honey can soothe a sore throat and other common symptoms associated with the infection.

• Eat well-balanced meals that are high in protein, low in salt and limit fat intake.
• Eat moderate amounts of fiber, such as fruits, vegetables, whole grains and legumes in your daily diet to help prevent constipation.
• Drink plenty of fluids (at least 8 glasses per day) to replace lost fluids caused by vomiting or diarrhea and reduce fatigue and maintain healthy body weight.

• Avoid foods that are high in fat and salt, as these can increase inflammation in the abdominal area and contribute to worsening of symptoms.
• Refrain from eating spicy or acidic foods as they can irritate intestines and inflame the abdomen.
• Do not eat processed, smoked, or deep-fried meats as they tend to have more sodium and saturated fat content.
• Stay away from refined carbohydrates such as white breads, white pastas, and sugary foods that provide little to no nutrition benefits.
• Limit milk and milk products such as cheese, yogurt, and cream as these may contain bacteria that could worsen infection if consumed in excess.

• Antibiotic Therapy: This is the most commonly used form of treatment for spontaneous bacterial peritonitis. Antibiotics are used in order to eliminate the bacteria that are the root of the illness and to lessen the inflammation that is present in the abdominal region.
• Intravenous Fluids: Intravenous fluids are used to replenish lost fluids and electrolytes due to vomiting, diarrhea, and other symptoms of spontaneous bacterial peritonitis.
• Paracentesis: In this procedure, a needle is inserted into the abdominal cavity in order to remove excess fluid that has built up due to inflammation caused by an infection. This procedure can help reduce pressure on organs in the abdomen and provide relief from pain and discomfort caused by the infection.
• Drainage of any infected fluid or abscesses: To reduce the amount of bacteria in the abdomen, a procedure may be performed to drain away any infected fluids and/or abscesses present.
• Peritoneal lavage: A procedure known as peritoneal lavage may be used to wash out bacteria from the peritoneal cavity in order to eliminate sources of infection and help fight further bacterial spread.
• Laparotomy or laparoscopy: In severe cases where infection has spread, a surgical procedure such as a laparotomy or laparoscopy may be necessary to excise infected tissue and control the spread of infection.

It is important to consult a gastroenterologist or an infectious diseases specialist who specializes in treating this condition if you have any of these symptoms mentioned above as it can lead to complications if left untreated which may potentially be life-threatening.

• Antibiotics: These are used to treat the infection caused by the bacteria that cause spontaneous bacterial peritonitis (SBP). Examples include aminoglycosides, cephalosporins, penicillins, and quinolones.
• Fluids and electrolytes: These are administered to replace lost fluids and electrolytes in patients with SBP. This can help prevent dehydration and other complications associated with the condition.
• Lactulose: This is a medication that helps reduce ammonia levels in the body, which can help reduce complications associated with SBP.
• Diuretics: These medications can help reduce fluid buildup in the abdomen, which can help improve symptoms of SBP. Examples include furosemide and spironolactone.
• Intravenous albumin: This is a protein-rich solution that is given intravenously to improve protein levels in patients with SBP who have low levels of albumin in their blood.

Generally, people with mild cases of SBP can recover within 1-2 days after starting treatment, while people with more severe cases may take up to a week or longer to fully recover.

No, the results of treatment for Spontaneous Bacterial Peritonitis (SBP) are not permanent.

Treatment with antibiotics is aimed at clearing the infection and improving symptoms, but there is a risk of recurrence if the underlying cause is not addressed.

• Monitor the patient closely for signs of relapse or recurrence of SBP such as fever, abdominal pain, or elevated white blood cell count.
• Administer follow-up imaging studies (ultrasound, CT scan, etc.) to monitor progress and detect any recurrent infection.
• Encourage lifestyle modifications such as avoiding alcohol and smoking to reduce the risk of recurrence.
• Provide patient education on symptoms of infection and when to seek medical attention.
• Maintain adequate hydration with fluids and electrolytes to prevent further complications from SBP.

Generally, treatments could include:

• Immediate antibiotic therapy: Depending on the patient’s situation and which antibiotic is being used, this could range from Rs. 500 - Rs. 5,000 per day.
• Surgical drainage/shunting: This procedure can cost anywhere from Rs. 50,000 - Rs. 2 lakhs.
• Laparoscopy/endoscopy procedures: These could cost anywhere from Rs. 10,000 - Rs. 30,000 each.
• Long-term antibiotics: The costs for this would vary based on which drugs are being prescribed as well as their potency and duration of use but can range between Rs. 100 - Rs. 2,500 per month or more in some cases.

Nausea, vomiting, diarrhea, and abdominal pain can occur during a course of antibiotics used to treat Spontaneous Bacterial Peritonitis (SBP).

A long-term side effect of SBP treatment can be drug resistant infections due to antibiotic overuse.

Other potential side effects of SBP treatments may include changes in liver or kidney function, allergies, hearing loss, dizziness and skin rashes.

If you think you may be suffering from Spontaneous Bacterial Peritonitis, you should make an appointment with a medical professional in your area as soon as possible. This condition can lead to complications such as 'septic shock, abscess formation, acute renal failure,' the treatment for which can take anywhere from a few months to several years, depending on the severity of the disorder.