In patients with ascites, both sexes are affected equally. While the etiology and incidence of hepatic failure differ between children and adults, in those individuals with ascites the incidence of SBP is roughly equal. A high index of suspicion must be maintained when caring for patients with ascites, particularly those with acute clinical deterioration. Findings on the abdominal examination can range from mild tenderness to overt rebound and guarding. In some cases, the abdominal examination mimics an acute intraabdominal catastrophe requiring emergency surgical evaluation.
Anaerobic organisms are rare because of the high oxygen tension of ascitic fluid.
In patients undergoing PD, this can be accomplished by obtaining a sample of the dialysate. In patients without a peritoneal catheter, diagnostic paracentesis must be performed. Direct inoculation of routine blood culture bottles at the bedside with 10 cc of ascitic fluid has been reported to significantly increase the sensitivity of microbiologic studies. It may be the result of poor culturing techniques or late-stage resolving infection. Nonetheless, these patients should be treated just as aggressively as those patients with positive cultures.