1115 Spontaneous Bacterial Peritonitis: We Are Still Behind

Abstract

INTRODUCTION: Spontaneous bacterial peritonitis (SBP) is an infection in the ascitic fluid when there is no evidence of intra-abdominal surgically treatable source of infection. It has an estimated in-hospital mortality rate of 20%. Despite the published guidelines, inappropriate diagnosis of SBP is frequent. In this study, we aim to measure the percentage of inappropriate diagnosis and treatment of SBP. METHODS: A retrospective study was conducted between Jan-2015 and Jan-2018. Based on the American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of Liver (EASL) two authors judged the adherence to the guidelines in diagnosis and management of SBP. A third author resolved conflicts. Data was analyzed by chi-square analysis/Mann Whitney U Tests, ANOVA, and t-tests. RESULTS: One hundred six patients were included in the study. 93.3% (98/106) of them were hospitalized. Mean age was 56.9 years (range 32-87). 58.5% (62/106) of the patients were males. Caucasian was the most common ethnicity, with 86.8% (92/106). Smoking use was present in 41.5%, and alcohol use was present in 28.3% of our sample. Alcohol was the most common cause of cirrhosis in 50% of the patients, and viral hepatitis was the second (21.7%). Prior SBP was found in 24.5% of the population. Mean WBC 11.1, Mean MELD-Na score 23.5 (range 8-42), and mean Albumin 2.8 (1.6-4.9). Polymorphonuclear neutrophils (PMN) was neutrocytic (>250) in 54.8% (46/106). 81.8% of the ascitic cultures were negative. 16.2% of the cultures grew one organism, and 1.9% of them were polymicrobial. Albumin was given in 62.1%, and 52.4% on day 1 and day 3, respectively. Hepatology was consulted on 80.2% of the patients. Authors judged that only 52.4% of patients were appropriately diagnosed, and only 67.3% were managed with appropriate treatment. Inpatient mortality documented in 5 patients. The readmission rate was 29.3%. CONCLUSION: SBP is a common complication of cirrhosis, that can be easily managed if we adhere to the published guidelines. In our population, nearly half of the patients were diagnosed and treated inappropriately; this was mostly due to misdiagnosis of SBP with secondary peritonitis or non-neutrocytic bacteriascites, starting antibiotics before performing the paracentesis, and even given broader antibiotics when it is not needed. Further efforts should stress to adopt the guidelines in clinical practice.

Spontaneous Bacterial Peritonitis: We Are Still Behind

“…This study was presented as a poster at the American College of Gastroenterology annual meeting [24].…”