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The most common bacteria causing SBP are gram-negative Escherichia coli and Klebsiella pneumoniae and gram-positive Streptococcus pneumoniae; usually only a single organism is involved.Historically, gram-negative bacteria were the main causative agents of spontaneous bacterial peritonitis, with Escherichia coli and Klebsiella spp. being the most frequently isolated organisms.22–25 However, major changes in the bacteriology of infections in patients with cirrhosis occurred over the last few decades with an increasing prevalence of gram-positive, quinolone-resistant, and multidrug-resistant bacteria.1,22,26 A rising prevalence of gram-positive bacteria was reported over the past years in North America, South America, and Europe representing at present 48%–62% of the isolated organisms.4,27,28,54 The most frequent gram-positive isolates are Streptococcus spp., Enterococcus spp., and Staphylococcus spp.4,27 The main isolated microorganisms in patients with spontaneous bacterial peritonitis are shown in Table 2(如下).The crux of this algorithm is Runyon's Criteria for secondary bacterial peritonitis, which requires two of these three features: total protein >1 g/dL, glucose <50 mg/dL (2.8 mM), and lactate dehydrodgenase above the upper limit of normal for serum.