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Publication Date

4-30-2015

Keywords

albumin, administration, dosage, bacterial infections, peritonitis, complications

Abstract

Purpose

Albumin is recommended for the treatment of spontaneous bacterial peritonitis (SBP) in patients at high risk for mortality. We assessed adherence to guidelines for administration of albumin for SBP in clinical practice at a private tertiary care hospital.

Methods

A retrospective clinical analysis of all cases of SBP diagnosed at a tertiary referral center from January 1, 2006, to December 31, 2012, was performed. Patients were identified electronically and manually validated. The appropriateness of albumin administration for treatment of SBP was assessed in all patients in whom mortality risk could be established and separately for patients who did or did not meet published trial exclusion criteria.

Results

A total of 57 patients diagnosed with SBP were identified, 43 of whom had sufficient data available to assess mortality risk. Of the 17 patients at high risk for mortality, 11 (65%) were treated with albumin. This number increased to 83% when only those eligible for published trials were considered. Of the 26 patients at low risk for mortality, 8 (31%) were treated with albumin. The rate of appropriate treatment for low-risk patients did not change when trial exclusion criteria were applied.

Conclusions

In the setting studied, approximately one-third of low-risk patients were inappropriately treated with albumin. Conversely, albumin administration in high-risk patients is lacking to some extent, especially in more medically complex patients. Appropriate albumin administration in SBP can significantly impact quality and cost of care.

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