Criteria for the diagnosis of SBP - one of the following:
(1) elevated peritoneal fluid WBC and positive fluid cultures
(2) signs and symptoms of peritonitis and positive fluid culture
Features of nosocomial spontaneous bacterial peritonitis due to MRSA:
(1) The presence of MRSA is a risk factor for increased mortality, especially if the patient becomes septic.
(2) The white blood cell count in the peritoneal fluid may be less than the cutoff seen with Gram-negative infections (> 250 cells per µL).
(3) Recurrent infections are common.
(4) Infections are associated with sepsis and spread to multiple sites.
(5) Failure of standard therapy should prompt use of vancomycin even before results of cultures are available.
(6) Infection control measures to screen for MRSA and to limit spread are important on wards used to treat patients with end-stage liver disease.
(7) Prophylaxis with norfloxacin should be discontinued on hospital admission since this is associated with MRSA SBP, especially if the patient is an MRSA carrier.
