With regard to patients suffering form spontaneous bacterial peritonitis, it seems counterintuitive that those patients tend to NEVER have anerobes as the causative agents despite the common leakage theory that should allow anerobes (that fill the gut) to leak whenever the opportunity is present? Is the leakage theory a sloppy theory? Do we need to tinker it a little bit? Should we adapt a new theory?! Or, should we go playing more in our labs hoping to uncover the real etiology and decipher this anerobes enigma?
The main bacteria causing spontaneous bacterial peritonitis (SBP) are Escherichia coli and Streptococcus viridans. Streptococcus pneumoniae is a rare cause of SBP but is part of invasive bacterial peritonitis (IBP) resulting from bacteremia.
Usually, 75% of the cases of spontaneous bacterial peritonitis are caused by infections by aerobic gram-negative organisms (50% of these being Escherichia coli). The remainder has been due to aerobic gram-positive organisms (mainly Viridans group streptococci).
Anaerobic organisms are rare because of the high oxygen tension of the ascitic fluid. A single organism is noted in 92% of cases, and 8% of cases are polymicrobial.
For details, please have a look at this Medscape article link under Pathophysiology and Etiology (1) and the article on pneumococcal peritonitis (2)
1. https://emedicine.medscape.com/article/789105-overview#a5
2. Article Spontaneous pneumococcal peritonitis diagnosed by qPCR
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