Silvey Scott, Patel Nilang, O'Leary Jacqueline G, Jakab Sofia S, Patton Heather, Rogal Shari, Markley John D, Cheung Ramsey, Patel Arpan, Morgan Timothy R, Bajaj Jasmohan S
Population Medicine, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia, USA.
Department of Medicine, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia, USA.
Clin Transl Gastroenterol. 2025 May 1;16(5):e00837. doi: 10.14309/ctg.0000000000000837.
Antibiotic overuse and subsequent antibiotic resistance lead to worse infection outcomes in cirrhosis. Secondary spontaneous bacterial peritonitis prophylaxis (SecSBBPr) is associated with higher SBP recurrence, but impact on non-SBP infections is unclear.
We studied patients with cirrhosis and SBP who were given SecSBPPr or not between 2009 and 2019 in 2 complementary national cohorts (Veterans Affairs Corporate Data Warehouse [VA-CDW] and non-VA TriNetX). Development of total non-SBP infections and specifically urinary tract infections (UTIs), bacteremia, pneumonia, and C. difficile using validated codes over 2 years was compared between those on SecSBPPr vs not. Multivariable regression for non-SBP infections was performed.
VA-CDW: Of 4,673 veterans with index SBP, 2,539 (54.3%) were started on SecSBPPr. In total, 1,406 (30.1%) developed non-SBP infections (13.5% UTI, 12.4% pneumonia, 8.5% bacteremia, and 6.8% C. difficile ). On multivariable regression, SecSBPPr was significantly associated with any non-SBP infection (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.10-1.44, P < 0.0001) and UTI (OR 1.21, 95% CI 1.01-1.45, P = 0.036). TriNetX: Of 6,708 patients with index SBP, 3,261 (48.6%) were started on SecSBPPr. In total, 1,932 (28.8%) patients developed non-SBP infections (13.4% UTI, 12.9% pneumonia, 8.6% bacteremia, and 5.9% C. difficile ). On multivariable regression, SecSBPPr was significantly associated with any non-SBP infection (OR 1.33, 95% CI 1.12-1.59, P < 0.0001), UTI (OR 1.35, 95% CI 1.07-1.71, P = 0.010), pneumonia (OR 1.35, 95% CI 1.06-1.72, P = 0.017), and bacteremia (OR 1.47, 95% CI 1.10-1.97, P = 0.009).
In 2 diverse US-based national cohorts of patients with cirrhosis and SBP, use of SecSBPPr was associated with a higher risk of non-SBP infections, especially urinary tract infections.
抗生素的过度使用及随后产生的抗生素耐药性会导致肝硬化患者的感染结局更差。继发性自发性细菌性腹膜炎预防（SecSBBPr）与自发性细菌性腹膜炎（SBP）的更高复发率相关，但对非SBP感染的影响尚不清楚。
我们研究了2009年至2019年间在两个互补的全国性队列（退伍军人事务部企业数据仓库[VA-CDW]和非VA的TriNetX）中患肝硬化和SBP且接受或未接受SecSBPPr的患者。使用经过验证的编码，比较了接受SecSBPPr与未接受SecSBPPr的患者在两年内总的非SBP感染以及特定的尿路感染（UTI）、菌血症、肺炎和艰难梭菌感染的发生情况。对非SBP感染进行了多变量回归分析。
VA-CDW：在4673例患有索引SBP的退伍军人中，2539例（54.3%）开始接受SecSBPPr。共有1406例（30.1%）发生了非SBP感染（13.5%为UTI，12.4%为肺炎，8.5%为菌血症，6.8%为艰难梭菌感染）。在多变量回归分析中，SecSBPPr与任何非SBP感染（比值比[OR]为1.26，95%置信区间[CI]为1.10 - 1.44，P < 0.0001）和UTI（OR为1.2仁95% CI为1.01 - 1.45，P = 0.036）显著相关。TriNetX：在6708例患有索引SBP的患者中，3261例（48.6%）开始接受SecSBPPr。共有1932例（28.8%）患者发生了非SBP感染（13.4%为UTI，12.9%为肺炎，8.6%为菌血症，5.9%为艰难梭菌感染）。在多变量回归分析中，SecSBPPr与任何非SBP感染（OR为1.33，95% CI为1.12 - 1.59，P < 0.0001）、UTI（OR为1.35，95% CI为1.07 - 1.71，P = 0.010）、肺炎（OR为1.35，95% CI为1.06 - 1.72，P = 0.017）和菌血症（OR为1.47，95% CI为1.10 - 1.97，P = 0.009）显著相关。
在两个不同的基于美国的肝硬化和SBP患者全国性队列中，使用SecSBPPr与非SBP感染的较高风险相关，尤其是尿路感染。
