title: Increased rate of spontaneous bacterial peritonitis among cirrhotic patients receiving pharmacologic acid suppression.
abstract: OBJECTIVE
  Patients with cirrhosis frequently receive proton pump inhibitor (PPI) or H2-receptor antagonist therapies. We investigated whether acid-suppressive therapy is associated with spontaneous bacterial peritonitis (SBP) in cirrhotic patients with ascites.
  
  
  METHODS
  We compared data from 65 hospitalized cirrhotic patients with paracentesis-proven SBP, collected from 2006 to 2009, with those of 65 contemporaneous, hospitalized cirrhotic patients without SBP (controls). We evaluated PPI use and analyzed the effects of covariates.
  
  
  RESULTS
  Patients with SBP had a significantly higher incidence of recent (past 7 days) PPI use (71%) than controls (42%). Of patients with SBP, 68% had no documented indication for PPI therapy. Based on multivariable logistic regression analysis, subjects who had not taken PPIs in the past 90 days were almost 70% less likely to develop SBP than those who had taken PPIs in the previous 7 days. Subjects who took PPIs within 8 to 90 days before hospitalization were 79% less likely to develop SBP than those who took PPIs within 7 days before hospitalization. There was no significant difference between patients who received no PPI therapy in the previous 90 days versus those who had taken PPIs in the previous 8 to 90 days (P = .58). Hyponatremia was associated significantly with SBP. There were no significant differences in length of hospital stay or 30-day survival for the SBP and control groups.
  
  
  CONCLUSIONS
  Pharmacologic acid suppression is associated with SBP in patients with advanced cirrhosis. Prospective studies are needed to determine the mechanism of this association and to determine whether reduced use of PPIs and H2-receptor antagonists reduce the incidence of SBP.
authors.affiliation: Department of Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Gati A
authors.initials: GA
authors.lastname: Goel
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshpande
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Geraldine S
authors.initials: GS
authors.lastname: Hall
authors.forename: David
authors.initials: D
authors.lastname: van Duin
authors.forename: William D
authors.initials: WD
authors.lastname: Carey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000150:complications; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D016022:Case-Control Studies; D005260:Female; D006635:Histamine H2 Antagonists / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000453:epidemiology* / Q000382:microbiology; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D012189:Retrospective Studies
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors