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Value of prophylaxis for cirrhotic bacterial infections requires review

PARIS — Patients who underwent primary prophylaxis treatment for spontaneous bacterial peritonitis had poorer outcomes compared with patients who previously experienced at least one episode and underwent secondary treatment, according to a presentation at the International Liver Congress 2018.

“Spontaneous bacterial peritonitis (SBP) is one of the most common infections in cirrhosis,” Jasmohan S. Bajaj, MD, from the Virginia Commonwealth University and McGuire VA Medical Center, said in his presentation. “However, given the increasing prevalence of gram-positive and resistant gram-negative bacterial and fungal infections in cirrhosis, the role of SBP prophylaxis remains uncertain.”

Prevention of SBP can be primary (before any episode) or secondary (after at least one episode). To compare the outcomes of primary vs. secondary prophylaxis for SBP, Bajaj and colleagues evaluated patient data included in the North American Consortium for Study of End-Stage Liver Disease registry.

The study comprised two groups matched on liver disease severity: 154 patients who received primary prophylaxis for SBP and 154 patients who received secondary prophylaxis.

Age, sex, presence of diabetes, admission albumin and MELD scores were similar between both groups, whereas patients who received secondary prophylaxis were more likely to be hospitalized within 6 months of baseline (90% vs. 65%; P < .0001), more likely to be admitted with hepatic encephalopathy therapy (86% vs. 69%; P = .001) and less likely to be admitted with a systemic inflammatory response syndrome (23% vs. 33%; P = .02) compared with those who received primary prophylaxis.

Additionally, patients who were treated with secondary prophylaxis were more likely to be admitted with infection (40% vs. 24%; P = .005) and have SBP at or during admission (22% vs. 10%; P = .004), have nosocomial SBP (6% vs. 05%; P = .01). Patients treated with primary prophylaxis were more likely to require ICU care (31% vs. 21%; P = .05) and had a higher rate of mortality (19% vs. 9%; P = .01).

“Despite being on primary or secondary SBP prophylaxis, 10% to 20% of patients developed SBP,” Bajaj noted in his conclusion. “The value of SBP prophylaxis — both primary and secondary — in current times requires re-evaluation.” – by Talitha Bennett

For more information:

Bajaj J, et al. GS-015. Presented at: International Liver Congress; Apr. 11-15, 2018; Paris, France.

Disclosure: Bajaj reports no relevant financial relationships.

Editor’s note: This item has been updated with clarifications from the presenter.