Spontaneous Bacterial Peritonitis in Nephrotic Syndrome — RACP Paediatrics MCQ

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HardNephrologySpontaneous Bacterial Peritonitis in Nephrotic SyndromeRACP Paediatrics

A 4-year-old child with nephrotic syndrome on prednisolone develops abdominal pain, fever, and peritoneal signs. Ascitic fluid analysis shows >250 neutrophils/mm³ with a single organism on culture. What is the most likely organism?

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Correct answer: D — Streptococcus pneumoniae

Children with nephrotic syndrome are at increased risk of spontaneous bacterial peritonitis (SBP) due to loss of immunoglobulins (particularly IgG) and complement in the urine, as well as ascites. Streptococcus pneumoniae is the most common causative organism. Gram-negative organisms (E. coli) are the second most common. Empirical treatment covers both organisms (e.g. ceftriaxone). Pneumococcal vaccination is important.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Nephrotic Syndrome