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PWE-126 Spontaneous Bacterial Peritonitis (sbp) Is Rare Among Routine Elective Day-case Therapeutic Paracentesis: Is Routine Fluid Analysis Justified?
  1. A Sugumaran,
  2. D Martin,
  3. M Czajkowski,
  4. A Yeoman
  1. Gwent Liver Unit, Newport, UK

Abstract

Introduction SBP is a serious infection in patients with cirrhosis and is associated with a high risk of mortality. EASL guidelines recommend a diagnostic tap and testing of white cell count on samples for all patients with new onset ascites or those hospitalised with deterioration. Whether this is still necessary in patients undergoing elective paracentesis for diuretic resistant ascites is unknown. We set out to determine the incidence of SBP in a cohort of patients undergoing ascitic tap on an inpatient or elective outpatient basis.

Methods We retrospectively analysed data from the Gwent Liver Unit database and compared rates of SBP between those having an ascitic tap during an acute admission and those who underwent paracentesis as an elective day-case. SBP was confirmed by the presence of >250 polymorphs/ml3.

Results In total 274 ascitic tap samples were reviewed, 176 from inpatients and 98 following elective paracentesis.

22 episodes of SBP were diagnosed (total incidence 8%).

21 episodes of SBP occurred among inpatients (incidence 12%) and just 1 in elective paracentesis patients (1%). However this individual had a previous SBP but unfortunately did not continue on her secondary antibiotic prophylaxis. Organisms were identified in 9 of 21 (42%) inpatients with SBP (3 E coli, 3 Klebsiella and 3 Streptococci) but none was identified in the only elective outpatient with SBP.

Conclusion The incidence of SBP is extremely low among elective outpatients so the recommendation to routinely test for SBP in this cohort is questionable unless clinical features suggest an acute deterioration.

Disclosure of Interest None Declared.

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