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We read with interest the review article by Wiest et al1 and applaud them for an excellent review highlighting spontaneous bacterial peritonitis SBP as a serious complication of cirrhosis. In particular, the emphasis on timely diagnosis of SBP and the use of appropriate antibiotics for treatment and prophylaxis is vital as emergence of resistant organism becomes a greater challenge. The section on prophylaxis draws the important distinction between community acquired and nosocomial SBP. In hepatology units, nosocomial infection is much more common than community acquired SBP, leading to many units having a policy of antibiotic prophylaxsis for high risk hospital inpatients only for the duration of admission,2 3 most commonly using norfloxacin. More recently, this has been recognised as a risk factor for healthcare associated infections. Due to a change in hospital antimicrobials policy we evaluated two consecutive cohorts …
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