Spontaneous Bacterial Peritonitis (SBP) Diagnosis
Diagnostic criteria for spontaneous bacterial peritonitis (SBP) in cirrhotic ascites. PMN count from diagnostic paracentesis is the gold standard.
Score interpretation
PMN < 250/mm³ and culture negative.
→ Continue cirrhosis management; repeat paracentesis if clinical suspicion persists.
PMN < 250/mm³ with a positive culture and no symptoms or signs of infection. Polymicrobial growth raises the possibility of bowel puncture or secondary peritonitis.
→ Repeat paracentesis when the culture result is known: treat as SBP if PMN ≥ 250/mm³, otherwise observe closely.
PMN < 250/mm³ with a positive culture and symptoms or signs of infection.
→ Treat with antibiotics as for SBP and repeat paracentesis at 48 hours.
PMN ≥ 250/mm³ with a negative culture: same prognosis as culture-positive SBP — treat as SBP.
→ Empirical antibiotics per local cirrhosis protocol, IV albumin on day 1 and day 3, repeat paracentesis at 48 hours.
PMN ≥ 250/mm³ with a single organism on culture.
→ Antibiotics guided by sensitivities, IV albumin on day 1 and day 3, repeat paracentesis at 48 hours; long-term antibiotic prophylaxis after recovery; assess for transplantation.
PMN ≥ 250/mm³ with polymicrobial growth suggests secondary (surgical) peritonitis.
→ Urgent abdominal CT and surgical review; broad-spectrum antibiotics covering anaerobes.
Interpretation bands for the SBP Criteria. Apply clinical judgement and local guidance.
References
- EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406–460.
- KASL clinical practice guidelines for liver cirrhosis: ascites and related complications 2026. Clin Mol Hepatol. 2026;32:961–1028.
Related
Curated clinical cross-links plus same-class fallbacks.
- AIR Score for Appendicitis · Diagnostic
- Alvarado Score (MANTRELS) for Appendicitis · Diagnostic
- New Orleans Head CT Decision Rule · Diagnostic
- MS Phenotype Classification (McDonald / Phenotype) · Diagnostic
- CHALICE Rule for Childhood Head Injury · Diagnostic
- STONE Score for Uncomplicated Ureteral Stones · Diagnostic
- Spironolactone (Ascites / Cirrhosis) · Aldosterone Antagonist / Potassium-Sparing Diuretic
- Furosemide (Ascites / Cirrhosis) · Loop Diuretic
- Anthrax Vaccine · Vaccine (Bacterial — Anthrax Prevention)
- Metronidazole (Bacterial Vaginosis) · Antibiotic (Nitroimidazole) — BV Treatment
- Fluorescein Sodium 2% Eye Drops · Diagnostic ophthalmic dye
- Indocyanine Green (Intravitreal Chromovitrectomy) · Diagnostic Dye — Vitreoretinal Surgery / ICG Angiography
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.