P1202 - Pre-Intervention Evaluation of Spontaneous Bacterial Peritonitis Antibiotic Prophylaxis Prescription Rates for High-Risk Cirrhotic Patients at Discharge

Ian W. Dale, DO¹, Arman Maqsudlu, MD¹, Ishita Dhawan, MD¹, Rachel Redfield, MD¹, Krysta Contino, MD^2
1Cooper University Hospital, Camden, NJ; ²Cooper University Hospital, Cooper Medical School at Rowan University, Camden, NJ

Introduction: Spontaneous bacterial peritonitis (SBP) occurs almost exclusively in patients with cirrhosis and ascites. Hospitalization for SBP is associated with a poor long-term prognosis and high mortality rates. In the high-risk cirrhotic, use of long-term antibiotic prophylaxis is associated with decreased risk of both bacterial infection and mortality. This project aims to determine the rate of proper antibiotic prophylaxis prescriptions for cirrhotic patients at risk of future SBP development prior to implementation of education and an electronic health record (EHR) reminder.

Methods: Retrospective medical record review was performed for patients with an admission diagnosis of cirrhosis, SBP, and/or ascites over an 18-month period (1/1/2021 – 6/30/2022). High risk patients were described as those with a diagnosis of cirrhosis + any of the following additional criteria: gastrointestinal bleeding, ≥1 episode of SBP, ascitic protein < 1.5 g/dL with either impaired renal or hepatic function, or hospitalization for other reasons with ascitic protein < 1 g/dL only. Qualifying patients were evaluated for documentation of antibiotic prescriptions for SBP prophylaxis at discharge. Primary outcomes include the number of qualifying patients and rate of antibiotic prescriptions.

Results: Of the 276 patients reviewed, 10 patients (3.6%) were already on SBP prophylaxis at time of admission. Of the 266 patients not on prophylaxis, 67 (25.2%) met at least one high-risk criteria. 7 (10.4%) of the 67 high-risk cirrhosis patients were discharged to hospice or passed away while inpatient. Of the remaining 60 living high-risk patients, 19 (31.7%) patients received antibiotics at time of discharge with 41 (68.3%) patients discharged without antibiotics.

Discussion: Only 31.7% of living high-risk patients were offered antibiotics at time of discharge, showcasing a preventative care gap with a large room for improvement. We suspect that a provider knowledge gap regarding SBP prophylaxis criteria to be at fault. Additionally, some criteria require a more intensive chart review at discharge, an already complex and error-prone transition of care period. Future directions involve educational sessions with an additional EHR best practice advisory on proper antibiotic prophylaxis guidelines at discharge followed by additional round of chart analysis to evaluate effectiveness of the interventions. Limitations include poor reliability of admission diagnosis accuracy.



Disclosures:


Ian W. Dale, DO¹, Arman Maqsudlu, MD¹, Ishita Dhawan, MD¹, Rachel Redfield, MD¹, Krysta Contino, MD². P1202 - Pre-Intervention Evaluation of Spontaneous Bacterial Peritonitis Antibiotic Prophylaxis Prescription Rates for High-Risk Cirrhotic Patients at Discharge, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.