P0921 - Clinical Outcomes of Antibiotic Use Before Paracentesis in Hospitalized Decompensated Cirrhosis Patients: A Retrospective Study

Onyinye Ugonabo, MD¹, Rajan Lamichhane, PhD, MSc², Pramod Pantangi, MD², Nayiri A. Derian, MD², Archana Ramalingam, MD², Abdelwahap Elghezewi, MD², Olachi Egbo, MD³, Shima Ghavimi, MD^4
1Marshall University Joan C. Edwards School of Medicine, Huntington, WV; ²Marshall University, Huntington, WV; ³Aurora Medical Center Oshkosh, Oshkosh, WI; ⁴Cedar Valley Digestive Health Center - CVMS, Cedar Falls, IA

Introduction: Spontaneous bacterial peritonitis (SBP) is associated with about 20-40% mortality rate in hospitalized patients. Hence, most clinicians have embraced antibiotic prophylaxis in at-risk hospitalized decompensated cirrhosis patients. Some however, begin empiric antibiotics before obtaining ascites fluid for culture. Our study aimed to identify possible outcomes of hospitalized decompensated liver cirrhosis patients that were on antibiotics < 24 and > 24 hours before paracentesis from the first day of admission.

Methods: We analyzed a total of 128 patients admitted with a decompensated cirrhosis in a tertiary hospital in West Virginia between 2018-2021. We compared the clinical outcomes between the patients who were on antibiotics for < 24hrs and > 24hrs using Fisher’s exact test and Wilcoxon Mann-Whitney tests. Patients on peritoneal dialysis, recent abdominal surgery, inflammatory bowel diseases, and a history of pelvic abscess were excluded. Statistical analyses were conducted using SAS version 9.4 (SAS Institute). P values < 0.05 were considered statistically significant.

Results: There was almost equal sex distribution with mean age of 61.3 years in the two groups. INR was found to be higher in patients on antibiotics > 24hrs compared to < 24hrs (1.48 vs 1.45, P = 0.018). Patients on antibiotics < 24hrs had higher platelet counts compared to those on antibiotics > 24 hours (163.4 vs 132.9, P = 0.046). In addition, paracentesis was delayed in the > 24 hours antibiotic group than in < 24 hours group (31 vs 13, P < 0.001). In terms of prognostic assessment, more patients in < 24 hours group had poor prognosis (child Pugh C) in comparism to > 24 hours group (39 vs 19, P = 0.027). Meld score and post paracentesis bleeding are not different in the two groups. Though not significant, we found more SBP in patients on antibiotics less than 24hrs (P = 0.539).

Discussion: Paracentesis is delayed in patients who are sicker and who probably need it the most. Longer duration of antibiotics prior to paracentesis could reduce the SBP yield, however, more sample size may be needed to confirm. We could infer that low platelet count and higher INR is likely in patients on antibiotics > 24 hours. Clinicians should be educated regarding the safety of ultrasound-guided paracentesis in low platelets and high INR patients. The limitations of the study are the small sample size and focus on the Appalachian region only which could limit the generalizability of our findings.



Disclosures:


Onyinye Ugonabo, MD¹, Rajan Lamichhane, PhD, MSc², Pramod Pantangi, MD², Nayiri A. Derian, MD², Archana Ramalingam, MD², Abdelwahap Elghezewi, MD², Olachi Egbo, MD³, Shima Ghavimi, MD⁴. P0921 - Clinical Outcomes of Antibiotic Use Before Paracentesis in Hospitalized Decompensated Cirrhosis Patients: A Retrospective Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.