PTH-096 Antibiotic use in primary and secondary prophylaxis of spontaneous bacterial peritonitis for liver cirrhosis patients

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Abstract

Introduction

Spontaneous Bacterial Peritonitis (SBP) is associated with 30%–50% mortality within 1 year and 70% chance of recurrence. EASL guidelines state prophylactic antibiotics should be given to patients with proven SBP (secondary prophylaxis) and patients with low total protein count (<15 g/L) in ascitic fluid with no prior history of SBP (primary prophylaxis). We audited whether these guidelines were followed and the associated mortality risk.

Methods

Data on all ascitic taps for patients with confirmed liver cirrhosis were collected retrospectively over a 12 month period.

Methods

SBP patients were assessed as to whether secondary prophylactic antibiotics were commenced. The same investigations were carried for bacterascites (BA) patients, including whether BA was treated. Previous ascitic taps were analysed for low total protein count (<15 g/L).

Methods

Cirrhotic patients without SBP or BA had their ascitic total protein count measured. If less than 15 g/L we assessed whether primary prophylactic antibiotics were started. We assessed mortality rate for all patients.

Results

Data collection period was from 15/10/2016 to 15/10/2017 yielding 860 ascitic taps. Of the 89 patients with liver cirrhosis; infection was identified in 33 patients; 16 patients with SBP and 17 patients with BA.

Results

Gram negative organisms were identified in 4/7 with SBP and 7/17 with bacterascites.

Results

Secondary prophylaxis was started in 10 of 16 (62.5%) patients with SBP. Of the patients where secondary prophylaxis was not started 3 of 6 (50%) died within 12 months. All 16 patients had a previous tap within 12 months (mean 3.4 months) with ascitic protein count less than 15 g/L. Primary prophylaxis was not started for any patients.

Results

10 of 17 (58%) BA patients received intravenous antibiotic treatment. From this group 6 of 10 (60%) received secondary prophylaxis. 6 of 17 (35%) patients died within 12 months and none of these patient commenced secondary prophylaxis. All 17 patients had a previous tap within 12 months (mean 4.2 month) with ascitic protein count less than 15 g/L.

Results

Of the 56 patients without SBP or BA 33 (58.9%) had an ascitic protein count of less than 15 g/L. No patients were started on primary prophylactic antibiotics. 6 of 33 (18.1%) patients with low protein ascites subsequently developed SBP when reviewed prospectively. No patients with ascitic protein count greater than 15 g/L have developed SBP or BA. 16 of 33 (48.4%) patients with low protein ascites died over the next 12 months.

Conclusion

66 of 89 (74%) patients had low protein ascites and 50% (33 of 66) subsequently developed either SBP or BA within 12 months. This highlights the importance of primary prophylactic antibiotics for patients with low protein ascites in the prevention of SBP and BA.

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