PWE-078 spontaneous bacterial peritonitis prophylaxis: are we following guidelines?

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Abstract

Introduction

Spontaneous bacterial peritonitis (SBP) is the most common serious infection in patients with cirrhosis, occurring in 25% of those who develop ascites. It is associated with significant morbidity and mortality rates of 20%–40%.1British Society of Gastroenterology (BSG) and National Institute of Clinical Excellence (NICE) guidelines recommend long-term prophylaxis (LTP) with Ciprofloxacin or Norfloxacin in patients with cirrhosis who have low ascitic fluid protein concentration (<15 g/L) with or without prior episode of SBP (primary LTP) or who have had an episode of spontaneous bacterial peritonitis (secondary LTP).1 2

Methods

We carried out a retrospective observational study using our electronic system for admissions with a diagnosis of ascites and cirrhosis across the East Kent Hospitals NHS Foundation Trust from April 2014 to April 2017. Ascitic fluid analysis Results were reviewed against discharge summaries to audit whether LTP was started according to national guidelines.

Results

337 cases of ascites with cirrhosis were identified (93 female: 244 male) with a median age of 58 (range 30–92 years). 61 out of 337 cases had a current or previous diagnosis of SBP. 5 out of 61 died during their admission. 10 out of 61 were discharged on secondary LTP and 46 patients were discharged without LTP. 11 out of 337 cases had low ascitic fluid protein with no current or previous episodes of SBP. None of these patients were discharged with primary LTP.

Conclusions

East Kent Trusts followed national guidelines in starting secondary LTP for SBP in 18% (10 out of possible 56) of cases and 0% of cases requiring primary LTP from April 2014 to April 2017. This low adherence rate may reflect lack of clinician awareness of guidelines for prescribing LTP for SBP in patients with ascites. There may also be a relation to local microbiology guidelines not following BSG or NICE guidelines on initiation of primary or secondary LTP for SBP. This study serves as a reminder to clinicians to carefully consider LTP in patients with ascites secondary to cirrhosis on each admission. We also recommend that trusts review local microbiology guidelines to ensure it adheres to national guidelines.

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