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The following is a summary of “Higher Rate of SBP Recurrence with Secondary SBP Prophylaxis Compared to No Prophylaxis in Two National Cirrhosis Cohorts,” published in the September 2024 issue of Gastroenterology by Silvey et al.

The bacteriology of spontaneous bacterial peritonitis (SBP) has evolved over time, leading to an increased rate of antibiotic resistance in patients receiving primary prophylaxis, speeding the discontinuation across the Veterans (VA) healthcare system.

Researchers conducted a retrospective study to re-assess the risk-benefit ratio of secondary SBP prophylaxis (SecSBPPr).

They used validated ICD-9/10 codes and accessed the VA Corporate Data Warehouse and Non-VA National TriNetX database to identify patients who survived their first SBP diagnosis with chart reviews from 2 VA centers (2009 to 2019). The prevalence of SecSBPPr was assessed, and outcomes were compared between patients who were and were not treated with SecSBPPr.

The results showed 4,673 VA who survived index SBP episodes, with 54.3% prescribed SecSBPPr. Multivariable analysis revealed a higher risk of SBP recurrence for those on SecSBPPr (HR 1.63 [1.40-1.91], P<0.001) and increased odds of fluoroquinolone resistance (OR 4.32 [1.36-15.83], P=0.03). In TriNetX, 6,708 patients who survived index SBP episodes were identified, with 48.6% on SecSBPPr. Multivariable analysis similarly indicated that SecSBPPr raised SBP recurrence risk (HR 1.68 [1.33-1.80], P<0.001). Both datasets showed an increased trend of SBP recurrence over time in patients with SecSBPPr, with consistent results at 6-month and 2-year follow-ups.

Investigators found that secondary prophylaxis with SBP was linked to a higher risk of SBP recurrence in 2 national datasets of over 11,000 patients, suggesting reevaluation in cirrhosis.

Source: journals.lww.com/ajg/abstract/9900/higher_rate_of_sbp_recurrence_with_secondary_sbp.1322.aspx