Rimola et al listed criteria for evaluating a patient with cirrhosis and ascites for peritonitis. These include detecting a failure to respond to therapy. The authors are from multiple universities in the Europe and the United States.
Criteria for failure to respond to therapy for spontaneous bacterial peritonitis:
(1) clinical deterioration (shock, etc) within a few hours of starting antibiotic therapy
(2) followup paracentesis 2 days after starting therapy shows a fluid WBC count that has decreased < 25% from the pretreatment level:
WBC on peritoneal fluid >= 0.75 * (pretreatment fluid WBC)
Responses to a failure to respond:
(1) Consider secondary peritonitis, especially if multiple bacteria, anaerobic bacteria and/or fungi have been isolated on the peritoneal fluid culture.
(2) Adjust antibiotic therapy to reflect susceptibilities from the fluid cultures.
Additional features might include:
(1) Detection of additional bacterial species.
(2) No change or increase in the number of bacteria.
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