When interpreting the results of a diagnostic paracentesis for a patient suspected of having spontaneous bacterial peritonitis (SBP), the primary indicator is the ascitic fluid neutrophil (polymorphonuclear leukocyte) count NICE NG50, McGibbon et al. 2007.
A neutrophil count of 250 cells/mm³ or more is diagnostic of SBP NICE NG50, NICE CKS, McGibbon et al. 2007. Conversely, a neutrophil count of less than 250 cells/mm³ effectively rules out SBP McGibbon et al. 2007.
In addition to the cell count and differential, ascitic fluid should also be sent for total protein and culture NICE NG50, McGibbon et al. 2007. It is important to note that ascitic fluid cultures are only positive in approximately 40% of SBP cases; therefore, a negative culture does not rule out SBP if the neutrophil count is elevated NICE NG50, McGibbon et al. 2007.
Prompt interpretation of these results is crucial for timely management, as SBP is a common and serious complication in patients with cirrhosis and ascites NICE CKS.
Key References
- NG50 - Cirrhosis in over 16s: assessment and management
- CKS - Cirrhosis
- NG240 - Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management
- NG51 - Suspected sepsis: recognition, diagnosis and early management
- NG195 - Neonatal infection: antibiotics for prevention and treatment
- CKS - Diarrhoea - adult's assessment
- CKS - Sepsis
- CKS - Olecranon bursitis
- (McGibbon et al., 2007): An evidence-based manual for abdominal paracentesis.