Spontaneous bacterial
peritonitis (SBP) is a frequent, life-threatening
bacterial infection in patients with
liver cirrhosis and
ascites.
Portal hypertension leads to increased bacterial translocation from the intestine. Failure to eliminate invading pathogens due to immune defects associated with advanced
liver disease on the background of
genetic predisposition may result in SBP. The efficacy of
antibiotic treatment and prophylaxis has declined due to the spread of multi-resistant bacteria. Patients with nosocomial SBP and with prior
antibiotic treatment are at a particularly high risk for
infection with resistant bacteria. Therefore, it is important to adapt empirical treatment to these risk factors and to the local resistance profile.
Rifaximin, an oral, non-absorbable
antibiotic, has been proposed to prevent SBP, but may be useful only in a subset of patients. Since novel
antibiotic classes are lacking, we have to develop prophylactic strategies which do not induce bacterial resistance. Farnesoid X receptor agonists may be a candidate, but so far, clinical studies are not available. New diagnostic tests which can be carried out quickly at the patient's site and provide additional prognostic information would be helpful. Furthermore, we need tools to predict antibiotic resistance in order to tailor first-line
antibiotic treatment of spontaneous bacterial
peritonitis to the individual patient and to reduce mortality.