Outcomes in Patients With Cirrhosis on Primary Compared to Secondary Prophylaxis for Spontaneous Bacterial Peritonitis

OBJECTIVES: Antibiotic prophylaxis is recommended for prevention of the first episode of spontaneous bacterial peritonitis (SBP; primary prophylaxis 1 degrees) and subsequent episodes (secondary prophylaxis 2 degrees). We aimed to compare outcomes in cirrhotic inpatients on 1 degrees vs 2 degrees SBP prophylaxis. METHODS: Data from North American Consortium for the Study of End-Stage Liver Disease were evaluated for cirrhosis details, reasons for admission/medications, inpatient course recorded, and outcomes over 90 days. Outcomes (intensive care units, acute kidney injury, inpatient/90-day mortality) were compared between the 2 groups after propensity-matching on admission model for end-stage liver disease (MELD) score and serum albumin. RESULTS: Among the 2,731 patients enrolled, 305 were on 1 degrees and 187 on 2 degrees SBP prophylaxis. After propensitymatching, 154 patients remained in each group. Patients on 1 degrees prophylaxis were more likely to have admission systemic inflammatory response syndrome (P50.02), with higher intensive care unit admissions (31% vs 21%; P 5 0.05) and inpatient mortality (19% vs 9%; P 5 0.01) than the 2 degrees prophylaxis group. Patients on 2 degrees prophylaxis had higher total (22% vs 10%; P50004), readmission (16% vs 9%; P50.03), andnosocomial (6% vs 0.5%; P50.01) SBPrateswithpredominantGram-negative organisms comparedto 1 degrees prophylaxis patients. At 90 days, 1 degrees prophylaxis patients had a highermortality (35% vs 22%; P50.02) and acute kidney injury incidence (48% vs 30%; P 5 0.04) compared to 2 degrees prophylaxis patients. DISCUSSION: In this inpatient cirrhosis study, despite prophylaxis, a high proportion of patients developed SBP, which was associated with mortality. Cirrhotic inpatients on 1 degrees prophylaxis had worse outcomes than those on 2 degrees prophylaxis when propensity-matched for the MELD score and serum albumin during the index admission and 90-day follow-up.