831Clinical Characteristics and Outcomes in Patients with Hospital-Acquired, Healthcare-Associated and Community-Acquired Spontaneous Bacterial Peritonitis

Background. Spontaneous bacterial peritonitis (SBP) is associated with poor clinical outcomes. Empiric treatment of SBP with a third-generation cephalosporin (3ceph) is standard of care. Studies show increasing rates of 3-ceph resistance, but limited data is available from the United States. Methods. Cirrhotic patients diagnosed with SBP at The Mount Sinai Hospital were retrospectively identified by ICD-9 code. Clinical and demographic data were collected. Health care-associated SBP (HCA-SBP) was defined as hospitalization in the prior 90 days; hospital-acquired SBP (HA-SBP) was defined as diagnosis after 72 hours of hospitalization. Among those who underwent repeat paracentesis, initial treatment failure was defined as <25% decrease in ascitic fluid neutrophil count on treatment day 2 or 3. Risk factors for 30-day mortality were analyzed. Results. Between January 1, 2010 and July 31, 2013, 186 patients with SBP were identified. Mean age was 59; 70% of patients were male. Average MELD score at time of SBP diagnosis was 26. Cirrhosis was due to hepatitis C in 53% of patients and alcohol in 33%. HCA-SBP was observed in 40%; HA-SBP in 30%; and community-acquired SBP (CA-SBP) in 30% of the patients. HA-SBP HCA-SBP CA-SBP