Outcomes in patients with spontaneous bacterial peritonitis utilizing first-line or alternative agents for secondary prophylaxis

Abstract

Purpose: The American Association for the Study of Liver Diseases guidelines recommend ciprofloxacin as a first-line option for spontaneous bacterial peritonitis (SBP) prophylaxis, citing literature that is over 30 years old. There is insufficient data and guidance for prophylaxis in cases of fluoroquinolone treatment failure or intolerance. This study aimed to evaluate outcomes in patients whose antimicrobial prophylaxis was switched from first-line therapies to an alternative agent versus those who were not switched following recurrent SBP.

Methods: This study was an institutional review board-approved retrospective chart review of patients admitted to University of Kentucky HealthCare from 2014 through 2020. Patients included were 18 years of age or older with a diagnosis of recurrent SBP. The primary outcome examined was SBP recurrence rate following initial prophylaxis failure. Additional analyses targeted secondary outcomes, including 6-month mortality, development of SBP complications, development of an adverse drug reaction, and development of multidrug-resistant pathogens.

Results: Fifty-three patients were identified with recurrent SBP and divided into 2 cohorts: 25 patients were switched from their original prophylactic agent while 28 patients continued on the same agent after SBP recurrence. Patients in the switch group had lower rates of recurrence (52% vs 100%). Additionally, these patients had lower 6-month mortality rates (24% vs 57.1%; P = 0.015). Thirteen patients in the no-switch group and 3 patients in the switch group required intensive care on a subsequent admission (46.4% vs 12%; P = 0.008). There were no significant differences between the groups in rates of other SBP complications.

Conclusion: Patients switched from their original prophylactic agent had lower rates of SBP recurrence with significantly lower 6-month mortality rates.

Keywords: antimicrobial prophylaxis; cirrhosis; liver disease; spontaneous bacterial peritonitis.