Outcomes associated with secondary spontaneous bacterial peritonitis (SBP) prophylaxis after hospital discharge in a nation-wide Swedish cohort

Background and aims Secondary spontaneous bacterial peritonitis (SBP) prophylaxis has been shown to reduce mortality. Recent evidence, however, suggests that SBP prophylaxis may lead to adverse outcomes such as antibiotic-resistant infections and increased SBP recurrence. Among patients with SBP, we evaluated the proportion who received SBP prophylaxis and its impact on readmission with SBP, readmission with other infections and mortality.Methods We conducted a register-based cohort study identifying hospitalized patients in Sweden diagnosed with a first episode of SBP from the Swedish National Patient Register. The primary outcome was rates of rehospitalization due to SBP, and the secondary outcomes were rehospitalization with sepsis, Clostridium difficile and mortality. Logistic regression was used to assess factors associated with receiving SBP prophylaxis and Cox regression was used to assess the association between secondary prophylaxis and subsequent rehospitalizations and mortality.Results Of 896 patients that met study criteria, 117 (13%) dispensed secondary SBP prophylaxis within 7 days of discharge. Using multivariable Cox regression, we found that receiving SBP prophylaxis was associated with the lower rates of readmission with SBP compared to patients that did not receive prophylaxis (aHR = 0.50, 95%CI = 0.28–0.89), with no significant increase in readmission with sepsis (aHR = 1.00, 95%CI = 0.20–4.93) or Clostridium difficile (aHR = 2.11, 95%CI = 0.71–6.25). No association with mortality was found (aHR = 0.96, 95%CI = 0.73–1.25).Conclusions In this cohort, only 13% of patients dispensed secondary antibiotic prophylaxis. These patients may experience lower rates of rehospitalization with SBP; however, no effect on mortality was seen. Further investigation into the impact of secondary SBP prophylaxis is needed.