Outcomes after hospitalisation with spontaneous bacterial peritonitis over a 13-year period: a retrospective cohort study

Abstract

Goals Assess outcomes in patients with an index presentation of spontaneous bacterial peritonitis (SBP) over a 13-year period. Background SBP, a bacterial infection of ascites, has a poor prognosis. Study Retrospective cohort study assessing mortality (standardised to 32 months) and prognostic factors in patients with SBP during two periods: period 1 (June 2006–November 2012) and period 2 (December 2012–May 2019). Results The study included 178 patients who were followed up for 11.6 (29.2) months. Mortality was high, with 12-, 24- and 32-month survival being 32%, 26% and 24%, respectively. Inpatient mortality was 36% with mortality in those surviving hospitalisation being 62%. Serum creatinine at the time of SBP diagnosis was an independent predictor of mortality at 32 months [hazard ratio (HR) 1.002, P = 0.023] and inpatient mortality (HR 1.003, P = 0.035). Positive ascitic fluid culture and ascitic fluid neutrophil count were independent predictors of 32-month (HR 1.679, P = 0.008) and inpatient mortality (HR 1.0001, P = 0.005), respectively. Patients in period 2 had lower ascitic fluid albumin (5.9 ± 3.3 g/L vs. 10.8 ± 5.4 g/L, P < 0.001), higher ascitic fluid neutrophil count (815.0 cells/mm3 vs. 345.0 cells/mm3, P < 0.001) and higher rates of hepatorenal syndrome-acute kidney injury (58 vs. 35%, P = 0.002). Mortality at 32 months and mortality in those surviving hospitalisation were similar at 78 vs. 73%, P = 0.392 and 66 vs. 58%, P = 0.355, for periods 1 and 2, respectively. Conclusions Despite more advanced initial presentations, mortality rates have remained similar over the last 13 years. Serum creatinine at the time of SBP diagnosis is an independent predictor of mortality.

Antibiotic treatment in cirrhotic patients

“…The SBP mortality rates have remained the same in recent years despite advances in medical knowledge[ 14 ], which may be a result of the increase in MDR. The emergence of MDR has made ineffective cephalosporins which have been the cornerstone of SBP empirical antibiotic treatment for many years.…”