Potential preventability of spontaneous bacterial peritonitis.

摘要

BACKGROUND: Antibiotic prophylaxis can reduce the incidence of the first episode and recurrent episodes of spontaneous bacterial peritonitis (SBP) in high-risk cirrhotic patients. However, recent data suggest that SBP prophylaxis may be underused. It is unclear how many cases of cirrhosis that develop SBP might actually be prevented with antibiotic prophylaxis. AIMS: To determine the number of "preventable" cases of SBP and the adherence to standard guidelines for the use of antibiotic prophylaxis. METHODS: A retrospective analysis of our patients diagnosed with SBP was performed. AASLD Guidelines (2004) for SBP prophylaxis include prior SBP, gastrointestinal (GI) hemorrhage, ascitic fluid (AF), protein /= 2.5 mg/dl. "Preventable (P) SBP" was defined as SBP occurring where prophylaxis was indicated but was not administered. Non-preventable (NP) SBP adherence to the guidelines. "Inevitable (I) SBP" were those cases of SBP occurring in the absence of a documented indication for prophylaxis. RESULTS: A total of 259 patients with cirrhosis underwent paracentesis; 29 had confirmed SBP. Eighteen of the 29 patients (62%) had "P-SBP", one (3%) had "NP-SBP", and ten (34%) had "I-SBP". In the P-SBP cases, the overlooked indications for prophylaxis were GI hemorrhage (n, %) (8, 44%), serum bilirubin >/= 2.5 mg/dl (6, 33%), prior SBP (2, 11%) and AF protein