The Use of Antibiotics for the Prophylaxis of Spontaneous Bacterial Peritonitis: A Retrospective Review and Quality Improvement Study

Background: Primary and secondary prophylaxis for spontaneous bacterial peritonitis (SBP) should be reserved for high-risk cirrhotic patients, such as those with a history of SBP, gastrointestinal (GI) hemorrhage, high Child–Pugh score, or low ascitic fluid protein (AFP) with liver and renal failure. Due to a multitude of reasons, many patients who require prophylaxis do not receive it. We present a retrospective analysis and quality improvement project. High-risk cirrhotic patients were identified to see if antibiotic prophylaxis was initiated upon admission and the 1-year outcomes for those individuals.

Methods and Results: One hundred twenty-six patients were included in the study. The mean age was 57.38 years. A total of 59.5% (n = 75) of patients were current or former alcohol users. A total of 54.8% (n = 69) of patients met the criteria for SBP prophylaxis; however, only 26% (n = 18) received it (p ≤ 0.073). Ciprofloxacin and cephalosporins were the most used antibiotics. Although none of the analyses for readmissions produced statistical significance, there were clinically more patients readmitted for SBP when prophylaxis was not prescribed. No patients who received prophylaxis were hospitalized within 6 months following a discharge for SBP. Only two of the 18 patients who received prophylaxis died compared to 30 of the 51 patients who did not (p ≤ 0.001). Twenty-eight of the 32 who met the criteria but did not receive prophylaxis were deceased within 1 year following discharge (p ≤ 0.042). When stratified by basic demographics, mortality was significant in the nonprophylaxis groups for males (p ≤ 0.0001), 25–30 body mass index (BMI) group (p ≤ 0.003), and alcohol use (p ≤ 0.002).

Conclusion: We intend to educate providers on the appropriate time to intervene to reduce mortality and subsequent hospitalizations for those with advanced liver disease.