Albumin Administration in Patients With Spontaneous Bacterial Peritonitis at a Tertiary Hospital: A Retrospective Clinical Analysis

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

Albumin Administration in Patients With Spontaneous Bacterial Peritonitis at a Tertiary Hospital: A Retrospective Clinical Analysis

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

Management of post-operative Crohn\u2019s disease in 2017: where do we go from here?

Introduction: Postoperative recurrence (POR) of Crohn\u2019s disease is common after surgical resection. How to best manage POR remains uncertain. Areas covered: In this review, we will first describe the natural course and the best modalities to diagnose this surgical sequela. We will then focus on the potential risk factors for relapse and highlight the main shortcomings in the current study designs and endoscopic and clinical scoring systems, which may partly explain the unexpected outcomes of recent clinical trials. Finally, we will propose a strategy to address the management of POR. Expert commentary: Anti-tumor necrosis factor (Anti-TNF) agents are the most effective therapy to prevent POR in Crohn\u2019s disease. Patient risk stratification and active monitoring with scheduled ileocolonoscopy are cornerstones of optimal POR management. Further studies are needed to address areas of uncertainty including timing and duration of therapy and the role of therapeutic drug monitoring in this settin