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Question 14#

A 56-year-old chronic alcoholic has a 1-year history of ascites. He is admitted with a 2-day history of diffuse abdominal pain and fever. Examination reveals scleral icterus, spider angiomas, a distended abdomen with shifting dullness, and diffuse abdominal tenderness. Paracentesis reveals slightly cloudy ascitic fluid with an ascitic fluid PMN cell count of 1000/µL.

Which of the following statements about treatment is true?

A. Antibiotic therapy is unnecessary if the ascitic fluid culture is negative for bacteria
B. The addition of albumin to antibiotic therapy improves survival
C. Repeated paracenteses are required to assess the response to antibiotic treatment
D. After treatment of this acute episode, a second episode of spontaneous bacterial peritonitis would be unlikely
E. Treatment with multiple antibiotics is required because polymicrobial infection is common

Correct Answer is B

Comment:

Spontaneous bacterial peritonitis is the occurrence of bacterial infection in preexisting ascitic fluid without bowel wall perforation. It is almost always caused by a single species; isolation of multiple species would suggest a bowel wall perforation. The typical patient has preexisting cirrhosis and ascites, and presents with fever and abdominal pain. Acute deterioration of liver function and hepatic encephalopathy are common. An ascitic fluid PMN cell count of greater than 250/µL confirms the diagnosis, even if the culture is negative. Standard antibiotic therapy is a fluoroquinolone or third-generation cephalosporin for 7 to 10 days. Response to therapy can be judged clinically, and repeated paracentesis is not usually necessary. The addition of albumin to antibiotic therapy has been shown to improve survival. Recurrence rates are high, and long-term prophylactic therapy with a fluoroquinolone is recommended.