Secondary Spontaneous Bacterial Peritonitis Prophylaxis Is Associated With a Higher Rate of Infections other than Spontaneous Bacterial Peritonitis in 2 US-Based National Cirrhosis Cohorts.

INTRODUCTION

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.

METHODS

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.

RESULTS

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).

DISCUSSION: 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.