UpToDate خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده:
4
September 2025
Selection of empiric therapy for suspected SBP depends on the patient's severity of illness and risk factors for multidrug-resistant pathogens. Local antibiograms should be reviewed prior to prescribing empiric antibiotics. Once culture results are available, therapy should be tailored. Refer to content on management of SBP for additional details.
Drug dosing is for adult patients with normal kidney function; refer to individual drug information monographs for more detail, including dose adjustments (eg, for organ impairment).
CRE: carbapenem-resistant Enterobacterales; ESBL: extended-spectrum beta-lactamase; IV: intravenously; MDR: multidrug-resistant; MRSA: methicillin-resistant Staphylococcus aureus; SBP: spontaneous bacterial peritonitis; VRE: vancomycin-resistant Enterococcus
* For noncritically ill patients suspected of having SBP, paracentesis should be performed as soon as possible, and antibiotics should be started immediately after paracentesis. For critically ill patients, antibiotics should be started prior to paracentesis if ascitic fluid samples cannot be obtained promptly. The diagnosis of SBP is established by an elevated ascitic fluid neutrophil count (≥250 cells/microL). If the ascitic neutrophil count is not consistent with SBP, we discontinue antimicrobial therapy for SBP and follow-up culture results.
¶ Some patients with SBP are asymptomatic, and the infection is detected following diagnostic paracentesis performed during hospitalization for other conditions (eg, acute gastrointestinal bleeding, acute kidney injury).
Δ The chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score includes subscores ranging from 0 to 4 for each of six components (bilirubin, serum creatinine, hepatic encephalopathy grade, international normalized ratio, amount of vasoactive medication necessary to prevent hypotension, and pulmonary status)[1]. Higher scores indicate more severe organ impairment.
◊ Some geographic regions have high rates of MDR gram-negative bacilli, even among community isolates (eg, eastern Europe, Russia, India, southeast Asia). Refer to UpToDate content on ESBLs.
§ We prefer carbapenems because they maintain activity against ESBL-producing pathogens, unlike piperacillin-tazobactam and other beta-lactams; observational data suggest that carbapenems decrease mortality in critically ill and nosocomial infections. Some experts recommend empiric piperacillin-tazobactam and reserve carbapenems for patients with recent exposure to piperacillin-tazobactam.
¥ For further details about vancomycin dosing, refer to related UpToDate content.
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