Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
Wake Forest Baptist Medical Center, Winston-Salem, NC, and Wingate University School of Pharmacy, Wingate, NC, USA.
Am J Health Syst Pharm. 2022 May 24;79(Suppl 2):S27-S32. doi: 10.1093/ajhp/zxac041.
The American Association for the Study of Liver Diseases has developed a standard of care for the treatment of patients with spontaneous bacterial peritonitis (SBP). Evidence examining the adherence rate to these guideline recommendations is limited. This study aimed to determine the adherence rate to guideline-directed therapy for patients with cirrhosis hospitalized with SBP.
This institutional review board-approved retrospective cohort study conducted at a large academic hospital evaluated the adherence rate to guideline-directed therapy in adult patients with cirrhosis hospitalized with SBP. Included hospitalized patients had a documented diagnosis of cirrhosis and acute SBP. The adherence rate to guideline-directed therapy was determined by receipt of paracentesis within 24 hours of admission, request of Gram stain and culture tests, avoidance of fresh frozen plasma, receipt of albumin on days 1 and 3, receipt of empiric antibiotics within 6 hours, receipt of SBP prophylaxis, receipt of deep vein thrombosis prophylaxis, and offer of pneumococcal vaccination.
A total of 110 patients were included. Provider adherence to goal-directed therapy was poor, with criteria met for only 10 (9.1%) patients. The therapies with the lowest adherence rates included SBP prophylaxis on discharge (54.5%), receipt of albumin on day 3 (42.7%), and offer of pneumococcal vaccination during admission (43.6%). Patients with a gastrointestinal consult were more likely than those without a consult to obtain albumin on day 1 (69.4% vs 36.8%, P = 0.001) and albumin on day 3 (52.8% vs 23.7%, P = 0.004).
This study demonstrated a lack of adherence to guideline-directed therapy for the management of SBP.
美国肝病研究协会已经制定了自发性细菌性腹膜炎（SBP）患者治疗的护理标准。检查这些指南推荐的依从率的证据有限。本研究旨在确定肝硬化合并 SBP 住院患者遵循指南指导治疗的比率。
这项在一家大型学术医院进行的机构审查委员会批准的回顾性队列研究评估了肝硬化合并 SBP 住院患者遵循指南指导治疗的比率。纳入的住院患者有明确的肝硬化和急性 SBP 诊断。通过以下标准确定指南指导治疗的依从率：入院 24 小时内进行腹腔穿刺术，要求进行革兰氏染色和培养试验，避免使用新鲜冷冻血浆，第 1 天和第 3 天使用白蛋白，在 6 小时内使用经验性抗生素，进行 SBP 预防，进行深静脉血栓预防，并提供肺炎球菌疫苗接种。
共纳入 110 例患者。提供者对目标导向治疗的依从性很差，只有 10 例（9.1%）患者符合标准。依从率最低的治疗方法包括出院时的 SBP 预防（54.5%），第 3 天使用白蛋白（42.7%），以及在住院期间提供肺炎球菌疫苗接种（43.6%）。有胃肠道咨询的患者比没有咨询的患者更有可能在第 1 天（69.4%比 36.8%，P=0.001）和第 3 天（52.8%比 23.7%，P=0.004）获得白蛋白。
本研究表明，肝硬化合并 SBP 患者在管理 SBP 时，缺乏对指南指导治疗的依从性。
