Spontaneous bacterial peritonitis: an update on evaluation, management, and prevention.

Spontaneous bacterial peritonitis (SBP) is a serious complication in patients with cirrhotic ascites. Greater understanding of the pathogenesis and risk factors for the development of SBP recently has improved our ability to prevent and treat the infection. The decreased threshold for performing diagnostic paracentesis in cirrhotic patients coupled with the use of non-nephrotoxic antibiotics have resulted in decreasing mortality rates for patients with SBP. Despite these advances, recurrence is common and often fatal. Thus, the prevention of SBP by diuresis and oral antibiotic prophylaxis has recently been studied. This review summarizes the recent developments in SBP, with an emphasis on patient management and prevention of SBP.