Spontaneous bacterial peritonitis awareness

Overview

Spontaneous bacterial peritonitis (SBP) is a serious infection of the fluid that builds up in the belly (ascites) in people with liver problems. It happens when bacteria get into that fluid and cause an infection, even without a clear source like a cut or surgery.

SBP is not common in the general population, but it is a frequent complication in people with cirrhosis and ascites.

SBP mainly affects people with long-term liver disease, especially those with cirrhosis and fluid buildup in the belly (ascites). It can also rarely occur in people with other conditions that cause ascites.

Symptoms

Common symptoms

• Fever or chills
• Belly pain or tenderness
• Nausea or vomiting
• Feeling generally unwell or very tired
• Diarrhea

Symptoms in children

• Fever
• Irritability or crying more than usual
• Poor feeding
• A swollen belly
• Lethargy (unusually sleepy or hard to wake)

Symptoms in older adults

• Confusion or sudden change in mental state
• Weakness or dizziness
• Little or no fever, but belly discomfort
• Loss of appetite

Causes

Main causes

• Bacteria from the gut moving into the ascites fluid in the belly
• A weakened immune system due to liver disease
• Inflammation in the lining of the belly (peritoneum) without an obvious source like a burst appendix

Risk factors

• Having cirrhosis and ascites (fluid in the belly)
• A prior episode of SBP
• Low protein levels in the ascites fluid
• Bleeding from the stomach or esophagus (variceal bleeding)
• Being hospitalized or having frequent medical procedures

When to see a doctor

See a doctor urgently if:

• If you have cirrhosis and develop fever, belly pain, or confusion – go to an emergency room right away.
• If you have a high fever with belly tenderness, seek urgent care.

Book a routine appointment if:

• If you have liver disease and notice new swelling in your belly or ankles, make an appointment with your doctor.
• If you have had SBP before, follow up regularly with your liver specialist.

Diagnosis

Doctors diagnose SBP by taking a sample of the fluid from your belly (called a paracentesis) and testing it for infection. They will also do blood tests and sometimes imaging scans.

Tests that may be done

• Paracentesis – using a needle to remove a small amount of belly fluid for testing
• Blood tests – to check for infection and liver function
• Urine tests – to rule out other infections
• Imaging (ultrasound or CT scan) – to look at the belly and liver

What to expect at your appointment

The paracentesis is done with a local numbing medicine, so you stay awake but feel little pain. The results usually come back in a few hours, and if infection is found, you will start treatment right away. Most people need to stay in the hospital for a few days.

Treatment

Treatment for SBP must start quickly to stop the infection from spreading. It usually involves antibiotics given through a vein (intravenous), and sometimes other medicines to help with symptoms or to prevent complications. You will likely be in the hospital for monitoring.

Self-care at home

• Get plenty of rest while your body fights the infection.
• Drink fluids as recommended by your healthcare team.
• Do not take any over-the-counter medicines without asking your doctor first, especially painkillers like ibuprofen.

Medical treatments

Doctors will prescribe antibiotics that target the most common bacteria. These are given intravenously (through a needle in your vein). Sometimes you may also receive a protein called albumin to help your kidneys work better. The length of treatment is usually 5 to 7 days, but may be longer if the infection is severe.

When is surgery considered?

Surgery is not typically needed for SBP. In very rare cases, if the infection does not clear or if there is a complication like a blocked bowel, surgery may be considered. Your doctor will discuss this if needed.

Living with this condition

After having SBP, you will need to watch for signs of infection and follow your liver care plan closely. Many people with cirrhosis need regular check-ups and tests to prevent another episode.

Lifestyle tips

• Avoid alcohol completely if you have liver disease.
• Take all prescribed medicines as directed.
• Keep a healthy weight and eat a balanced diet low in salt.

Diet and exercise

Eat small, frequent meals with plenty of vegetables and lean protein. Limit salt to help control fluid buildup. Gentle exercise like walking can help maintain strength, but ask your doctor before starting any new activity.

Mental health and emotional wellbeing

Being diagnosed with SBP and living with liver disease can be stressful and overwhelming. You may feel anxious or depressed. It is important to talk about these feelings with your healthcare team or a counselor. You are not alone.

Prevention

In people with cirrhosis and ascites, the risk of SBP can be lowered with long-term antibiotics (prophylaxis). This is especially recommended for those who have had SBP before. Not everyone needs this, so ask your doctor.

Vaccines

It is a good idea for people with liver disease to get vaccinated against flu, pneumonia, and hepatitis B. These vaccines can prevent infections that might trigger SBP.

Screening programmes

If you have cirrhosis, your doctor may check your belly fluid protein levels and schedule regular appointments. There is no routine screening test for SBP itself, but being alert to symptoms is key.

Complications

If left untreated

• The infection can spread to the blood (sepsis), which is life-threatening.
• Kidney failure can develop.
• The infection can worsen liver function and lead to hepatic encephalopathy (confusion and coma).
• Without treatment, SBP can be fatal.

Long-term outlook

With early diagnosis and proper antibiotics, most people recover from SBP. However, because it often occurs in people with serious liver disease, the outlook also depends on the health of your liver. Many people go on to live well with careful management and follow-up care.

Find support

Local organisations

• British Liver Trust · UK
• American Liver Foundation · USA

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