| Potential Preventability of Spontaneous Bacterial Peritonitis. | |
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MedLine Citation:
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PMID: 21394460 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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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 ≤ 1 g/dl, or serum bilirubin ≥ 2.5 mg/dl. "Preventable (P) SBP" was defined as SBP occurring where prophylaxis was indicated but was not administered. "Non-preventable (NP) SBP" was defined as SBP that occurred despite proper 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 ≤ 1 g/dl (2, 11%). Of the P-SBP, 78% were community-acquired; 22% were nosocomial. In-hospital mortality in the P-SBP was 16% (n = 3). Only one-third of patients who survived SBP received long-term outpatient prophylaxis after discharge. CONCLUSIONS: Many cases of SBP could be prevented by adhering to the AASLD guidelines. GI hemorrhage is the most frequently overlooked indication for SBP prophylaxis. Studies identifying the reasons for non-adherence to guidelines and developing interventions to increase utilization are warranted. |
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Authors:
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Saowanee Ngamruengphong; Kenneth Nugent; Ariwan Rakvit; Sreeram Parupudi |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-3-11 |
Journal Detail:
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Title: Digestive diseases and sciences Volume: - ISSN: 1573-2568 ISO Abbreviation: - Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-3-11 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7902782 Medline TA: Dig Dis Sci Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Department of Internal Medicine, Division Gastroenterology, Texas Tech University Health Science Center, 3601 4th street, Lubbock, TX, 79430, USA, saowanee.ngamruengphong@ttuhsc.edu. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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