Introduction: Spontaneous bacterial peritonitis (SBP) is an infection of ascitic fluid seen commonly in cirrhosis. Increased hospital admissions and long-term antibiotic use have resulted in drug resistance and a mortality rate of 20%-30%. With increasing prevalence of SBP, researchers have attempted to elucidate the factors contributing to disease severity, but this investigation has yet to occur on a national scale. The aim of this study is to examine the U.S. trends in SBP hospitalizations as well as the factors most commonly associated with complications of disease. Methods: The National Inpatient Sample is the largest all-payer inpatient database consisting of approximately 20% of all inpatient admissions to nonfederal hospitals in the United States. We collected data from years 2012 - 2014. Cases of SBP and common co-morbidities as secondary diagnoses were identified using the International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9 CM). Rates of SBP complications (sepsis, hepatorenal syndrome, and death) and the associated odds ratio were determined. Results: Admissions for SBP have gradually increased over time, while incidence of sepsis and hepatorenal syndrome (HRS) have decreased over this period. There is a greater prevalence of HRS (9.6%) amongst this cohort, as compared to sepsis (0.13%). Despite these trends, mortality remained relatively constant at 9% each year. The most common co-morbidities affecting this population include cirrhosis (36.8%), diabetes mellitus (DM2; 28%), and hypertension (HTN; 24.4%). The illnesses that were associated with increased incidence of complications and death include gastrointestinal bleed (GIB; OR 3.068, p<0.001) and hepatic encephalopathy (HE; OR 2.032, p<0.001). Conclusion: These findings reflect recent trends in SBP hospitalizations and illustrate the effect that various co-morbidities have on the clinical course. Despite increased SBP infections from 2012 - 2014, the decreased incidence of HRS and sepsis are likely a result of early medical therapy, as advocated by previous studies. In contrast, both GIB and HE are complications of long-standing, untreated cirrhosis and portend a poor prognosis. However, GIB may induce an immunocompromised state, thereby worsening SBP.