Journal Article

P367 3 year audit of spontaneous bacterial peritonitis (SBP) in patients attending a tertiary centre day case unit for paracentesis

Shaikh, Aneeqa, Caulton, Nicola, Aram, Beverley, Scott, Robert, Garrity, Helen

2024

Overview

IntroductionRecurrent ascites is a recognised complication of advanced liver disease, with many patients requiring repeated elective paracentesis. This can be performed by a day case unit. SBP occurs in 1.5–3.5% of outpatients and 10% of inpatients with ascites.1 SBP in an elective setting differs from acute hospitalisations without a good evidence base, leading to varied management.AimTo report outcomes in all patients diagnosed with SBP from our elective paracentesis service over a 3 year period. Primary outcomes were overall and 30-day mortality. Secondary outcomes were readmission rates and total inpatient days (LoS).MethodsThis is a retrospective, single-centre, audit of total ascitic white cells (WCC) arising from 1576 elective paracenteses performed January 2021 - December 2023. SBP was defined as ascitic WCC ≥ 0.5 x109/L. Paracenteses for non-cirrhotic causes were excluded.Results62 instances of SBP occurred in 1576 drains (3.93%), corresponding to 39 episodes in 33 patients. Median age was 60. 24 (72.7%) were male. 19 (57.6%) had alcohol-related cirrhosis, 10 (30.3%) metabolic, 3 (9.1%) mixed and 1 (3%) autoimmune hepatitis. Median UKELD was 55. Mean ascitic WCC was 1.68 x109/L. 26 (66.7%) had never had SBP, 9 (23.1%) had 1, 3 (7.7%) had 2 and 1 (2.6%) had 3 prior SBP episodes. 23 (60%) had no SBP prophylaxis, 11 (28.2%) Co-trimoxazole and 5 (12.8%) Ciprofloxacin. 24 (61.5%) were on proton pump inhibitors. 15 (38.4%) were on non-selective beta blockers. 15 (45.5%) are deceased, 4 (12.1%) transplanted and 18 (54.5%) alive.Of 39 SBP episodes, 27 (69.2%) were treated as inpatients, 11 (29.7%) as ambulatory and 1 excluded due to prior admission. Of those directly admitted, 1 (3.7%) required further inpatient treatment compared with 6 (54.5%) of those ambulatory. In those admitted, mean total LoS was 7.4 days vs 5.8 days in those ambulatory. Table 1 compares patient characteristics:Abstract P367 Table 1 Admitted Ambulatory Frequency 27 11 Age (median) 59 64.5 Overall mortality 10 (40%) 4 (40%) 30-day mortality 2 (8%) 2 (20%) Ascitic WCC (x109/L) 1.76 1.5 Sodium 132 134.3 Creatinine 86.6 102.1 Bilirubin 47.1 20 Albumin 31.9 28.8 Prothrombin Time 14.1 12.5 CRP 47.8 15 Acute Kidney Injury 5 (19.2%) 3 (37.5%) ConclusionIn elective patients diagnosed with SBP, direct admission reduced readmission rates but increased total LoS. Overall mortality was no different. With elective paracentesis units, a new evidence base and algorithm should be developed, and may identify a sub-group of patients that could be safely managed as ambulatory with reassessment after a course of antibiotics.ReferenceAithal GP, Palaniyappan N, China L, et al. Guidelines on the management of ascites and cirrhosis. Gut. 2021;Jan;70(1):9–29.

• Publisher: BMJ Publishing Group Ltd and British Society of Gastroenterology,BMJ Publishing Group LTD
• Subject: Antibiotics / Ascites / Bilirubin / Ciprofloxacin / Cirrhosis / Cotrimoxazole / Creatinine / Hepatitis / Leukocytes / Liver cirrhosis / Liver diseases / Mortality / Peritonitis / Poster Presentations / Prophylaxis / Prothrombin / Proton pump inhibitors