Peritonitis in ICU: spontaneous bacterial, secondary, and tertiary

Also known as Spontaneous bacterial peritonitis · SBP · Secondary peritonitis · Tertiary peritonitis · Catheter-related peritonitis

Peritonitis: inflammation of peritoneum. THREE types in ICU: (1) SPONTANEOUS BACTERIAL PERITONITIS (SBP): infection of ascites WITHOUT obvious intra-abdominal source, in cirrhotic patients. Diagnosis: ascitic PMN 250 cells/mm³. Treatment: cefotaxime/ceftriaxone, albumin (prevents HRS). (2) SECONDARY PERITONitis: infection from intra-abdominal source (perforation, abscess, post-surgical leak). Polymicrobial. Treatment: surgery (source control) + broad-spectrum antibiotics. (3) TERTIARY PERITONITIS: persistent or recurrent peritonitis in critically ill, often with resistant organisms (Enterococcus, Candida, Pseudomonas, MRSA). High mortality. Also: CAPD peritonitis (peritoneal dialysis patients).

high27 referencesUpdated 20 Aug 202612 min readVerification in progress

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7 MCQs

^[2] ^[15] ^[17] ^[18] ^[23] ^[26]

Meet the patient

A 54-year-old man with alcohol-related cirrhosis (Child-Pugh C, MELD-Na 22) presents with 36 hours of abdominal pain, fever, and worsening confusion. He is drowsy, MAP 65, HR 112, febrile to 38.4, with a distended tense abdomen and a positive fluid thrill. Diagnostic paracentesis returns turbid fluid. The bedside dipstick reads leukocyte esterase 3+.^[1]

Two questions decide his next hour: is this SBP or a perforated viscus? (a polymicrobial culture or anaerobes reclassifies it as secondary and sends him to theatre), and does he need albumin? (he does — his creatinine is climbing, and albumin halves his risk of hepatorenal syndrome). Hold those two and the management below slots into place.^[2]

References27Show

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