Introduction Spontaneous bacterial peritonitis is a serious and life-threatening complication of cirrhosis, especially common in hospitalised patients. Antibiotic prophylaxis is effective but can lead to an increased incidence of hospital-acquired infections such as Clostridium difficle.
Aim We evaluated whether two alternative prophylaxis agents were equally efficacious in preventing SBP, and the impact on risk of C difficile infection.
Method A consecutive, cohort study of hospitalised patients with cirrhosis and ascites, over a 3-year period in a tertiary hospital. In the first cohort (2007–2009), ascitic patients requiring prophylaxis received Norfloxacin 400 mg/d during their hospital admission. In the second cohort (2009–2010) patients received prophylactic Co-trimoxazole 960 mg/d during their hospital admission. Data were extracted by case note review and the two cohorts compared.
Results 174 patients admitted during 2007–2010 accounted for 231 hospital episodes with ascites. The Norfloxacin group had 154 episodes and the Co-trimoxazole group had 77. The mean age of the cohort was 57.4 years (SD 12.4) and 62% were male. Alcoholic cirrhosis was the major aetiology accounting for 79% of cases. The mean Child-Pugh and UKELD scores were 10.7 and 54 respectively. The overall incidence of SBP in our cohort was 19%. Abstract P08 table 1 demonstrates that the incidence of hospital acquired SBP, prophylaxis failure and mortality was not statistically different between the two therapies. However, selective bowel sterilisation with Co-trimoxazole did not lead to an increase C difficle infection rate.
Conclusion Survival of cirrhotic patients with ascites is inversely related to severity of Liver disease, worsened with development of infections such as spontaneous bacterial peritonitis and C difficle. This study shows that Co-trimoxazole inpatient prophylaxis against SBP is as effective as quinolone based regimes, but has the advantage of a dramatic reduction in C difficle infection. At the same time the importance of measures like hand hygiene compliance, environmental cleanliness and strict policy of in hospital antibiotic prescribing cannot be underestimated.
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