189.A 54-year-old man with a history of hepatitis C, alcohol abuse, and
cirrhotic ascites presents with increasing abdominal girth and abdominal
pain. He complains of increasing difficulty breathing, especially when lying
down, caused by worsening ascites. On physical examination, the patient
is cachectic and appears older than his stated age. He has a diffusely tender
abdomen and tense ascites. The liver is palpable 4 cm below the costal
margin. Vitals include a BP of 110/65 mm Hg, HR of 110 beats per minute,
RR of 22 breaths per minute, and temperature of 102°F. Which of the fol-
lowing is the most common organism seen in spontaneous bacterial peri-
tonitis?
a. Pseudomonas aeruginosa
b. Enterococcus
c. Streptococcus pneumoniae
d. Enterobacteriaceae
e. Streptococcus viridans
Fever 189