Evaluation of prophylactic antibiotic regimens on recurrence and mortality in spontaneous bacterial peritonitis

• Main Authors: Shelley S. Glaess, Rebecca L. Attridge, Rebecca L. Brady, Russell T. Attridge
• Format: Article
• Language: English
• Published: Elsevier 2019-11-01
• Series: Annals of Hepatology
• Subjects: Cirrhosis; Spontaneous bacterial peritonitis; Antibiotic prophylaxis; Recurrence; Mortality
• Online Access: http://www.sciencedirect.com/science/article/pii/S166526811932215X

Introduction and objectives: Limited data describe current SBP epidemiology and specific secondary SBP prophylactic regimens, leading to variable prescribing practices. This work aims to compare 90-day and one-year SBP recurrence and mortality based on secondary SBP antibiotic prophylaxis regimens. Materials and methods: We performed a retrospective cohort of patients >18 years with an SBP diagnosis from 2010 to 2015 at two academic institutions. Eligible patients had ascitic PMN counts ≥250 cells/mm3 or a positive ascitic culture. Patients were compared based on secondary SBP prophylaxis regimens (i.e., daily, intermittent, or no prophylaxis). Results: Of 791 patients with ascitic fluid samples, 86 patients were included. Antibiotic prophylaxis included daily (n = 34), intermittent (n = 36), or no prophylaxis (n = 16). Nearly half of SBP episodes had a positive ascitic fluid culture; 50% were gram-negative pathogens, and 50% were gram-positive pathogens. Daily and intermittent regimens had similar rates of recurrence at 90-days (19.4% vs. 14.7%, p = 0.60) and one-year (33.3% vs. 26.5%, p = 0.53). Similarly, mortality did not differ among daily and intermittent regimens at 90-days (32.4% vs. 30.6%, p = 0.87) or one-year (67.6% vs. 63.9%, p = 0.74). When comparing any prophylaxis vs. no prophylaxis, there were no differences in 90-day or one-year recurrence or mortality. Conclusions: In patients with a history of SBP, our data indicate similar outcomes with daily, intermittent, or no secondary antibiotic prophylaxis. With available data, including ours, demonstrating a changing epidemiology for SBP pathogens, further data is required to determine if traditional approaches to secondary SBP prophylaxis remain appropriate.