PWE-090 West midlands multi-centre trainee-LED audit in the assessment, management and prophylaxis of spontaneous bacterial peritonitis

Introduction Spontaneous bacterial peritonitis (SBP) is a common but potentially fatal complication in patients with cirrhosis and ascites. In the first audit performed by West Midlands Research in Gastroenterology (WMRIG) trainees, we aimed to assess practice of assessment, management and primary and secondary prophylaxis of SBP according to national standards, in addition to the feasibility of regional project delivery. Methods This trainee-led, retrospective, multi-centre study identified patients admitted with cirrhosis and ascites between Sep-Dec 2016. Outcomes of SBP and mortality were retrospectively followed-up for up to 1 year (median 8 months). Practice was audited against EASL, BSG and NICE standards. Heterogeneity between sites was assessed with chi 2 and time-to-event analyses undertaken using Kaplan-Meier plots. Results Trainees across 8 West Midlands hospitals identified 227 patients (mean age 58, SD 13; 65% male) with 282 admissions. Cirrhosis was attributed to alcohol (79%), NAFLD (10%), autoimmune (4%) and viral (3%), and was graded Child-Pugh B in 48% and C in 49%. 18% were elective admissions and 7% had a previous history of SBP. Ascitic aspirates were performed in 83% (range: 60%–92%, p=0.019), in Conclusions Our pilot study has been successful in highlighting deficiencies and variations in the assessment, management and prophylaxis of SBP. These Results will inform and prioritise future regional quality improvement strategies to improve outcomes in patients with advanced chronic liver disease.