Silvey Scott, Patel Nilang R, Tsai Stephanie Y, Nadeem Mahum, Sterling Richard K, Markley John D, French Evan, O'Leary Jacqueline G, Bajaj Jasmohan S
School of Public Health, Virginia Commonwealth University, Richmond, Virginia, USA.
Department of Medicine, Division of Nephrology, Virginia Commonwealth University and Richmond Virginia Medical Center, Richmond, Virginia, USA.
Am J Gastroenterol. 2025 May 1;120(5):1066-1075. doi: 10.14309/ajg.0000000000003075. Epub 2024 Sep 4.
Spontaneous bacterial peritonitis (SBP) bacteriology has changed over time. Reappraisal of primary SBP prophylaxis showed an increased rate of resistance in patients on primary prophylaxis with resultant discontinuation of this prophylaxis throughout the Veterans Affairs (VA). We aimed to re-evaluate the risk-benefit ratio of secondary SBP prophylaxis (SecSBPPr).
Using validated International Classification of Diseases-9/10 codes, we used the VA Corporate Data Warehouse and the Non-VA National TriNetX database to identify patients in 2 different large US systems who survived their first SBP diagnosis (with chart review from 2 VA centers) between 2009 and 2019. We evaluated the prevalence of SecSBPPr and compared outcomes between those who started on SecSBPPr vs not.
We identified 4,673 veterans who survived their index SBP episode; 54.3% of whom were prescribed SecSBPPr. Multivariable analysis showed higher SBP recurrence risk in those on vs off SecSBPPr (hazards ratio 1.63 [1.40-1.91], P < 0.001). This was accompanied by higher fluoroquinolone resistance odds in SecSBPPr patients (odds ratio = 4.32 [1.36-15.83], P = 0.03). In TriNetX, we identified 6,708 patients who survived their index SBP episode; 48.6% were on SecSBPPr. Multivariable analysis similarly showed SecSBPPr increased SBP recurrence risk (hazards ratio 1.68 [1.33-1.80], P < 0.001). Both data sets showed higher SBP recurrence trends over time in SecSBPPr patients. Results remained consistent at 6-month and 2-year timepoints.
In 2 national data sets of >11,000 patients with SBP, we found that SecSBPPr was prescribed in roughly half of patients. When initiated, SecSBPPr, compared with no prophylaxis after SBP, increased the risk of SBP recurrence in multivariable analysis by 63%-68%, and this trend worsened over time. SecSBPPr should be reconsidered in cirrhosis.
自发性细菌性腹膜炎（SBP）的细菌学情况随时间发生了变化。对原发性SBP预防措施的重新评估显示，接受原发性预防的患者耐药率增加，导致美国退伍军人事务部（VA）全面停止了这种预防措施。我们旨在重新评估继发性SBP预防（SecSBPPr）的风险效益比。
我们使用经过验证的国际疾病分类第9/10版编码，通过VA企业数据仓库和非VA国家TriNetX数据库，在美国两个不同的大型系统中识别出在2009年至2019年间首次SBP诊断后存活的患者（对2个VA中心进行病历审查）。我们评估了SecSBPPr的患病率，并比较了开始接受SecSBPPr治疗与未接受治疗的患者的结局。
我们识别出4673名在首次SBP发作后存活的退伍军人；其中54.3%的人接受了SecSBPPr治疗。多变量分析显示，接受SecSBPPr治疗的患者SBP复发风险高于未接受治疗的患者（风险比1.63[1.40 - 1.91]，P < 0.001）。同时，接受SecSBPPr治疗的患者氟喹诺酮耐药几率更高（优势比 = 4.32[1.36 - 15.83]，P = 0.03）。在TriNetX中，我们识别出6708名在首次SBP发作后存活的患者；48.6%的人接受了SecSBPPr治疗。多变量分析同样显示，SecSBPPr增加了SBP复发风险（风险比1.68[1.33 - 1.80]，P < 0.001）。两个数据集均显示，接受SecSBPPr治疗的患者SBP复发趋势随时间增加。在6个月和2年时间点的结果保持一致。
在两个包含超过11000名SBP患者的全国性数据集中，我们发现约一半的患者接受了SecSBPPr治疗。在多变量分析中，与SBP后不进行预防相比，开始使用SecSBPPr治疗会使SBP复发风险增加63% - 68%，且这种趋势随时间恶化。对于肝硬化患者，应重新考虑SecSBPPr治疗。
