skip to main content

Not SBP Neutrophils Below 250 — SCE Infectious Diseases MCQ

Instant feedback + full explanation. One question, done properly.

EasyHealthcare-Associated InfectionsNot SBP Neutrophils Below 250SCE Infectious Diseases

A 50-year-old man with cirrhosis develops new ascites. Diagnostic paracentesis is performed. The ascitic fluid shows: neutrophils 50/µL, protein 12 g/L, albumin-ascites gradient (SAAG) 18 g/L. He is afebrile. Is this SBP?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — No — ascitic neutrophils <250/µL excludes SBP; SAAG >11 g/L confirms portal hypertension-related ascites; the low protein (<15 g/L) does place him at risk of developing SBP and primary prophylaxis should be considered

SBP is defined as ascitic fluid neutrophils ≥250/µL (with or without positive culture). This patient's count of 50/µL excludes active SBP. However, the low ascitic protein (<15 g/L) indicates impaired opsonising capacity — this places him at risk of developing SBP. Primary SBP prophylaxis (Norfloxacin 400 mg daily) should be considered if he also has impaired renal function, hyponatraemia, or Child-Pugh ≥9. SAAG >11 g/L confirms portal hypertension as the cause of ascites.

Reference: EASL 2024 – Cirrhosis; BSG 2021 – Ascites