Diagnosis and Differentiation of Bacterial Peritonitis in Cirrhotic Patients

Differentiating between spontaneous bacterial peritonitis and secondary bacterial peritonitis is crucial in cirrhotic patients. Misdiagnosing and treating as SVP when it is actually SBP can lead to the patient not getting better, as SBP requires different management and antibiotics. Red flags for SBP versus SVP include overt peritonitis, complex loculated fluid on ultrasound, presence of multiple organisms on gram stain, and lack of improvement after antibiotic therapy. Diagnostic criteria for SVP includes underlying cirrhosis, an absolute neutrophil count of greater than 250, and exclusion of secondary bacterial peritonitis.