Methods: Adult cirrhosis patients with SBP admitted over four years (2009-2012) were identified through a clinical database. SBP was defined as ascites fluid with >250 PMN/mm3. EPZ-6438 datasheet Nosocomial cases were defined as SBP occurring greater than 48 hours after hospitalization. Patients with non-neutrocytic bacterascites,

SBP diagnosed prior to transfer, and secondary peritonitis were excluded. Results: Of 341 patients with cirrhosis and peritonitis, 99 patients met criteria for SBP; 23 cases (23%) were identified as nosocomial (NA-SBP) and 76 cases (77%) as community-acquired (CA-SBP). Patients with NA-SBP had significantly higher admission MELD scores (NA-SBP 28, 95% CI 22.9-32.8, vs. CA-SBP 22, 95% CI 19.6-23.9, p=0.02), driven primarily by higher bilirubin levels (NA-SBP 13.0 mg/dL, 95% CI 7.4-18.6, vs. CA-SBP 5.9 mg/dL, 95% CI 4.3-7.5, p=0.01). Exposure to antibiotics prior to paracen-tesis was more common among patients with NA-SBP than those with CA-SBP (91.3% vs. 56.2%, p=0.002). Patients with NA-SBP had significantly Fulvestrant longer hospitalizations (NA-SBP 16.9 days, 95% CI 12.1-21.7, vs. CA-SBP 8.4 days, 95% CI 6.4-10.3, p =0.0001) with longer intervals preceding

diagnostic paracentesis (NA-SBP 6.2 days, 95% CI 4.3-8.0, vs. CA-SBP 0.5 days, 95% CI 0.4-0.7, p= 0.0001). Ascites culture yield was low in this cohort (21/99, 21%), with a large proportion of culture-positive ascites growing multi-drug resistant organisms (9/21, 43%). Among NA-SBP patients, only 2/23 (9.5%) yielded positive ascites cultures. 12/23 (52%) of NA-SBP patients had

a separate infection noted prior to medchemexpress SBP diagnosis. Kaplan-Meier survival analysis revealed 30-day mortality was significantly higher in patients with NA-SBP (p=0.004, Figure 1). A multivariate Cox proportional hazards model indicated NA-SBP (HR 3.2, p=0.002) was a significant predictor of mortality. Conclusions: NA-SBP carries a high 30-day risk of mortality relative to CA-SBP. After controlling for other important mortality correlates, NA-SBP was found to be an independently significant predictor for death. As hospitalized cirrhotic patients are prone to systemic infections, it is unclear if elevated ascites neutrophils represent true SBP; rather, these counts may be a surrogate marker for overall systemic infection and consequently a higher risk of death. Further prospective study is now needed to better characterize NA-SBP. Disclosures: Neeral L. Shah – Grant/Research Support: Boehringer Ingelheim Curtis K. Argo – Consulting: Wellstat Diagnostics; Independent Contractor: Genentech/Roche Stephen H. Caldwell – Advisory Committees or Review Panels: Vital Therapy; Consulting: Wellstat diagnostics; Grant/Research Support: Genfit, Gilead Sciences Patrick G. Northup – Grant/Research Support: Hemosonics, Bristol Meyer Squibb The following people have nothing to disclose: Nicolas M. Intagliata, Zachary Henry, Nitin K.