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Colon Ascendens Stent Peritonitis (CASP) - a Standardized Model for Polymicrobial Abdominal Sepsis
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Published on: December 18, 2010

Potential preventability of spontaneous bacterial peritonitis.

Saowanee Ngamruengphong1, Kenneth Nugent, Ariwan Rakvit

  • 1Department of Internal Medicine, Division Gastroenterology, Texas Tech University Health Science Center, 3601 4th street, Lubbock, TX 79430, USA. saowanee.ngamruengphong@ttuhsc.edu

Digestive Diseases and Sciences
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PubMed
Summary

Many cases of spontaneous bacterial peritonitis (SBP) in cirrhosis patients could be prevented with antibiotic prophylaxis. Gastrointestinal hemorrhage is the most common overlooked reason for not using prophylaxis.

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Published on: March 15, 2024

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Clinical Medicine

Background:

  • Spontaneous bacterial peritonitis (SBP) is a serious complication in cirrhotic patients.
  • Antibiotic prophylaxis is recommended for high-risk individuals but may be underutilized.
  • The proportion of SBP cases that are preventable remains unclear.

Purpose of the Study:

  • To quantify the number of "preventable" spontaneous bacterial peritonitis (SBP) cases in cirrhotic patients.
  • To assess adherence to established guidelines for antibiotic prophylaxis in SBP prevention.
  • To identify common reasons for the underuse of SBP prophylaxis.

Main Methods:

  • Retrospective analysis of cirrhotic patients diagnosed with SBP.
  • Application of American Association for the Study of Liver Diseases (AASLD) guidelines (2004) for SBP prophylaxis indications.
  • Categorization of SBP cases into "Preventable (P-SBP)", "Non-preventable (NP-SBP)", and "Inevitable (I-SBP)".

Main Results:

  • Out of 29 SBP cases, 18 (62%) were classified as P-SBP.
  • Gastrointestinal hemorrhage was the most frequent overlooked indication for prophylaxis in P-SBP cases (44%).
  • In-hospital mortality for P-SBP was 16%, and only one-third of survivors received long-term outpatient prophylaxis.

Conclusions:

  • Adherence to AASLD guidelines for SBP prophylaxis can prevent a significant number of SBP cases.
  • Gastrointestinal hemorrhage is a critical, often missed, indication for SBP prophylaxis.
  • Further research is needed to understand and address the reasons for guideline non-adherence in SBP prophylaxis.