Spontaneous Bacterial Peritonitis: We Are Still Behind.

Area of Science:

• Hepatology
• Infectious Diseases
• Clinical Medicine

Background:

• Spontaneous bacterial peritonitis (SBP) is a serious infection of ascitic fluid in patients with cirrhosis.
• Despite established guidelines, accurate diagnosis and management of SBP remain challenging in clinical practice.

Purpose of the Study:

• To evaluate adherence to American Association for the Study of Liver Diseases (AASLD) and European Association for the Study of Liver (EASL) guidelines in diagnosing and managing SBP.
• To identify factors contributing to guideline non-adherence in SBP diagnosis and treatment.

Main Methods:

• Retrospective study of 106 hospitalized patients diagnosed with SBP between January 2015 and January 2018.
• Two independent authors assessed guideline adherence for SBP diagnosis and management based on AASLD and EASL criteria.

Main Results:

• Only 52.4% of patients were diagnosed according to guidelines, with common errors including misdiagnosis and premature antibiotic administration.
• Guideline adherence for SBP management was also suboptimal, with only 67.3% receiving appropriate treatment.
• Inpatient mortality was 4.7%, and the 30-day readmission rate was 29.3%.

Conclusions:

• Adherence to published guidelines for SBP diagnosis and management is insufficient in clinical practice.
• Enhanced efforts are required to improve guideline implementation for SBP to optimize patient care and outcomes in cirrhosis.
• Misdiagnosis and inappropriate antibiotic use are key barriers to effective SBP management.